Provider Demographics
NPI:1588998595
Name:LEWIS, LAURA JEAN (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:JEAN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3454 OAK ALLEY CT STE 200
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1370
Mailing Address - Country:US
Mailing Address - Phone:419-460-0413
Mailing Address - Fax:844-443-0075
Practice Address - Street 1:3454 OAK ALLEY CT STE 200
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1370
Practice Address - Country:US
Practice Address - Phone:419-460-0413
Practice Address - Fax:844-443-0075
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH180943163W00000X
OHE 0004386101Y00000X
OH6498103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No163W00000XNursing Service ProvidersRegistered Nurse
No101Y00000XBehavioral Health & Social Service ProvidersCounselor