Provider Demographics
NPI:1316254253
Name:LEWIS, GARY ALAN (MS, CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:ALAN
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3355 MISSION AVE
Mailing Address - Street 2:STE 123
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-1326
Mailing Address - Country:US
Mailing Address - Phone:760-529-4975
Mailing Address - Fax:760-529-4761
Practice Address - Street 1:3355 MISSION AVE
Practice Address - Street 2:STE 123
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-1326
Practice Address - Country:US
Practice Address - Phone:760-529-4975
Practice Address - Fax:760-529-4761
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP17003235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist