Provider Demographics
NPI:1427283365
Name:LEWIS, CHARLA JEAN (MACCC-SLP)
Entity type:Individual
Prefix:
First Name:CHARLA
Middle Name:JEAN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9040 EXECUTIVE PARK DR STE 105
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4630
Mailing Address - Country:US
Mailing Address - Phone:423-312-9999
Mailing Address - Fax:865-769-0801
Practice Address - Street 1:9040 EXECUTIVE PARK DR STE 105
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4630
Practice Address - Country:US
Practice Address - Phone:423-312-9999
Practice Address - Fax:865-769-0801
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002574235Z00000X
TNSPOOOOOO2574235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist