Provider Demographics
NPI:1174710230
Name:LEWIS, BELINDA S (MA-CCC-SLP)
Entity type:Individual
Prefix:
First Name:BELINDA
Middle Name:S
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MA-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 THORN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-6717
Mailing Address - Country:US
Mailing Address - Phone:651-772-6520
Mailing Address - Fax:
Practice Address - Street 1:1121 THORN ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-6717
Practice Address - Country:US
Practice Address - Phone:651-772-6520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6336235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist