Healthcare Provider Details

I. General information

NPI: 1427911668
Provider Name (Legal Business Name): IMANI LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3819 S WABASH AVE APT 2W
CHICAGO IL
60653-1549
US

IV. Provider business mailing address

3819 S WABASH AVE APT 2W
CHICAGO IL
60653-1549
US

V. Phone/Fax

Practice location:
  • Phone: 708-238-5468
  • Fax:
Mailing address:
  • Phone: 708-238-5468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.113443
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: