Healthcare Provider Details

I. General information

NPI: 1255452405
Provider Name (Legal Business Name): LINDA DEMING LEWIS PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 N MICHIGAN AVE SUITE 2222
CHICAGO IL
60601-7401
US

IV. Provider business mailing address

180 N MICHIGAN AVE SUITE 2222
CHICAGO IL
60601-7401
US

V. Phone/Fax

Practice location:
  • Phone: 312-360-1333
  • Fax: 312-461-9586
Mailing address:
  • Phone: 312-360-1333
  • Fax: 312-461-9586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071003631
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: