Individual
DR. JASON L LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
10513 HIDDEN OAKS LN N, CHAMPLIN, MN 55316-3045
(763) 951-3252
Mailing address
10513 HIDDEN OAKS LN N, CHAMPLIN, MN 55316-3045
(763) 951-3252
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP4841
MN
Other
Enumeration date
03/17/2010
Last updated
03/17/2010
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