Basic Information
| Provider Information | |||||||||
| NPI: | 1639442601 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MCD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11942 NE GLISAN ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972202143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032523238 | ||||||||
| FaxNumber: | 5032538654 | ||||||||
| Practice Location | |||||||||
| Address1: | 11942 NE GLISAN ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972202143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032523238 | ||||||||
| FaxNumber: | 5032538654 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2012 | ||||||||
| LastUpdateDate: | 02/05/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | 23590 | OR | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.