Provider Demographics
NPI:1407739675
Name:LEWIS, SENA ROSE
Entity type:Individual
Prefix:
First Name:SENA
Middle Name:ROSE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SENA
Other - Middle Name:ROSE
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3954 S HAZEN DR
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-1237
Mailing Address - Country:US
Mailing Address - Phone:307-231-4567
Mailing Address - Fax:
Practice Address - Street 1:3954 S HAZEN DR
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-1237
Practice Address - Country:US
Practice Address - Phone:307-231-4567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist