Individual
TIMOTHY LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, CCC-SLP
Contact information
Practice address
2002 SUDDERTH DR, RUIDOSO, NM 88345-6119
(575) 257-2368
(575) 257-2141
Mailing address
2002 SUDDERTH DR, RUIDOSO, NM 88345-6119
(575) 257-2368
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP6851
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
850441031
—
NM
Enumeration date
12/17/2013
Last updated
09/10/2024
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