Basic Information
| Provider Information | |||||||||
| NPI: | 1851689228 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.A., CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2842 DONJOY DR | ||||||||
| Address2: | |||||||||
| City: | HEBRON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410488111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593943877 | ||||||||
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| Practice Location | |||||||||
| Address1: | 405 RIO VISTA LN | ||||||||
| Address2: | |||||||||
| City: | RISING SUN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 470409497 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124382219 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2011 | ||||||||
| LastUpdateDate: | 07/19/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SP9909 | OH | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.