Provider Demographics
NPI:1396811170
Name:LEWIS, VICKI MARIE (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:VICKI
Middle Name:MARIE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MISS
Other - First Name:VICKI
Other - Middle Name:MARIE
Other - Last Name:SWITZER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:133 BENMORE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4143
Mailing Address - Country:US
Mailing Address - Phone:407-644-4883
Mailing Address - Fax:407-644-3697
Practice Address - Street 1:133 BENMORE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4143
Practice Address - Country:US
Practice Address - Phone:407-644-4883
Practice Address - Fax:407-644-3697
Is Sole Proprietor?:No
Enumeration Date:2006-11-25
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005118235Z00000X
FLSA10035235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist