Provider Demographics
NPI:1154599926
Name:LEWIS, NANCY SUE (MA, CCC-A)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:SUE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15223 LIONS PSGE
Mailing Address - Street 2:
Mailing Address - City:LEO
Mailing Address - State:IN
Mailing Address - Zip Code:46765-9594
Mailing Address - Country:US
Mailing Address - Phone:260-627-8252
Mailing Address - Fax:
Practice Address - Street 1:12101 LIMA RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-8903
Practice Address - Country:US
Practice Address - Phone:260-637-3166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23001897231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist