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Individual
MRS. DIANNE LACEY LEWIS
Active
Individual
MRS. DIANNE LACEY LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.C.D., CCC-SLP
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP003612
GA
235Z00000X
Speech-Language Pathologist
SP0000004940
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000693316B
—
GA
05
—
000693316C
—
GA
Enumeration date
04/18/2007
Last updated
02/24/2013
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