Individual
MR. PRESTON LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SLP
Contact information
Practice address
3158 HALEY CT, BENTON, AR 72019-2068
(501) 555-5555
Mailing address
3158 HALEY CT, BENTON, AR 72019-2068
(501) 555-5555
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SPP8046
AR
Other
Enumeration date
02/10/2012
Last updated
06/30/2021
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