1134422801 NPI number — MS. KATHERINE V LEWIS MA CCC-SLP

Table of content: MS. KATHERINE V LEWIS MA CCC-SLP (NPI 1134422801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134422801 NPI number — MS. KATHERINE V LEWIS MA CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIS
Provider First Name:
KATHERINE
Provider Middle Name:
V
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134422801
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1717 FRONT STREET
Provider Second Line Business Mailing Address:
CHILDREN'S DEVELOPMENT GROUP
Provider Business Mailing Address City Name:
KEESEVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12929
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-834-7071
Provider Business Mailing Address Fax Number:
518-882-0282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 SCHOOL STREET
Provider Second Line Business Practice Location Address:
PERU ELEMENTARY SCHOOL
Provider Business Practice Location Address City Name:
PERU
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-643-6000
Provider Business Practice Location Address Fax Number:
518-643-2043
Provider Enumeration Date:
12/17/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 022563-1 . This is a "OFFICE OF PROFESSIONS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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