Individual
JESSICA LYNN LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1002 SW 14TH PL, WAGONER, OK 74467-7744
(918) 687-5588
(918) 686-6885
Mailing address
1002 SW 14TH PL, WAGONER, OK 74467-7744
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
11/04/2013
Last updated
11/04/2013
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