Healthcare Provider Details

I. General information

NPI: 1427056746
Provider Name (Legal Business Name): LEWARK ENTERPRISES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 S STATE ROAD 135 STE C
GREENWOOD IN
46142-1443
US

IV. Provider business mailing address

637 S STATE ROAD 135 STE C
GREENWOOD IN
46142-1443
US

V. Phone/Fax

Practice location:
  • Phone: 317-865-1110
  • Fax: 317-865-0221
Mailing address:
  • Phone: 317-865-1110
  • Fax: 317-865-0221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22004037A
License Number StateIN

VIII. Authorized Official

Name: MRS. NANCY MARIE LEWARK
Title or Position: PRESIDENT/ADMINISTRATOR
Credential: MA, CCC-SLP
Phone: 317-865-1110