Provider Demographics
NPI:1437495991
Name:LEWIS, JENAFER REBECCA (SLP)
Entity type:Individual
Prefix:MRS
First Name:JENAFER
Middle Name:REBECCA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 SW STONEPOINT AVE
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72713-4374
Mailing Address - Country:US
Mailing Address - Phone:816-738-3441
Mailing Address - Fax:
Practice Address - Street 1:3300 SW STONEPOINT AVE
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72713-4374
Practice Address - Country:US
Practice Address - Phone:816-738-3441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011035384235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist