Provider Demographics
NPI:1407369366
Name:TUCKER- LEWIS, ANNE LYNNETTE (CPRS)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:LYNNETTE
Last Name:TUCKER- LEWIS
Suffix:
Gender:F
Credentials:CPRS
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:LYNNETTE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 S JAMES RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1696
Mailing Address - Country:US
Mailing Address - Phone:614-743-1192
Mailing Address - Fax:
Practice Address - Street 1:1989 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-1101
Practice Address - Country:US
Practice Address - Phone:614-278-0170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.004442175T00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist