Provider Demographics
NPI:1730503012
Name:LEWIS, KIMBERLY (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 HAWTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-1509
Mailing Address - Country:US
Mailing Address - Phone:440-956-5821
Mailing Address - Fax:
Practice Address - Street 1:112 N LAKE ST
Practice Address - Street 2:
Practice Address - City:SOUTH AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-2824
Practice Address - Country:US
Practice Address - Phone:440-965-5821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.6750235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist