Provider Demographics
NPI:1194358606
Name:LEWIS, STEPHANIE T (CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:T
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 1:11721 KEMP MILL RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-1722
Mailing Address - Country:US
Mailing Address - Phone:301-649-8085
Mailing Address - Fax:301-649-8092
Practice Address - Street 1:850 HUNGERFORD DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1718
Practice Address - Country:US
Practice Address - Phone:240-740-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD01937LOtherLICENSE