Provider Demographics
NPI:1811240641
Name:LEW, JESSICA ANNE (MS, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:ANNE
Last Name:LEW
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 COOPER RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-2801
Mailing Address - Country:US
Mailing Address - Phone:914-523-6331
Mailing Address - Fax:
Practice Address - Street 1:3 COOPER RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-2801
Practice Address - Country:US
Practice Address - Phone:914-523-6331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022080-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist