Individual
GARY LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSW
Contact information
Practice address
801 5TH ST, SIOUX CITY, IA 51101-1394
(701) 279-2010
(701) 279-5649
Mailing address
400 E 10TH ST, WACONIA, MN 55387-4552
(952) 442-9770
(952) 442-3620
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
00416
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0140111
—
IA
01
—
54513
BLUE CROSS OF IOWA
IA
Enumeration date
06/16/2005
Last updated
04/28/2008
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