Healthcare Provider Details

I. General information

NPI: 1780506188
Provider Name (Legal Business Name): TRICIA L LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 WINDSOR PL STE A
CHAMPAIGN IL
61820-7773
US

IV. Provider business mailing address

2104 WINDSOR PL # PLACEA
CHAMPAIGN IL
61820-7772
US

V. Phone/Fax

Practice location:
  • Phone: 217-552-1058
  • Fax: 855-848-7422
Mailing address:
  • Phone: 217-552-1058
  • Fax: 855-848-7422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149010618
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: