MEDICARE: MS. IZJAHANA LEWIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	S.2411600	OH
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA177782	OH

General Provider Information

NPI Number	:	1699405159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IZJAHANA LEWIS

Provider Business Mailing Address
First Line	:	5900 LANDERBROOK DR STE 301
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-4020
Country	:	US
Telephone Number	:	216-417-8813
Fax Number	:

Provider Business Practice Location Address
First Line	:	5900 LANDERBROOK DR STE 301
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-4020
Country	:	US
Telephone Number	:	216-417-8813
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2022
Last Update Date	:	03/02/2026

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