Provider Demographics
NPI:1871883843
Name:LEWIS, MARY MICHAEL (SLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:MICHAEL
Last Name:LEWIS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 QUARRIER ST STE A
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-6002
Mailing Address - Country:US
Mailing Address - Phone:304-342-7852
Mailing Address - Fax:304-756-8695
Practice Address - Street 1:1313 QUARRIER ST STE A
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-6002
Practice Address - Country:US
Practice Address - Phone:304-342-7852
Practice Address - Fax:304-756-8695
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-1044235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist