Provider Demographics
NPI:1285791517
Name:LEWIS, DIANA Y (M A, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:Y
Last Name:LEWIS
Suffix:
Gender:F
Credentials:M A, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 LEDGE ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3073
Mailing Address - Country:US
Mailing Address - Phone:603-966-1000
Mailing Address - Fax:
Practice Address - Street 1:141 LEDGE ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3073
Practice Address - Country:US
Practice Address - Phone:603-966-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4872235Z00000X
NH1400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist