Healthcare Provider Details

I. General information

NPI: 1598897621
Provider Name (Legal Business Name): NANCY MARIE LEWARK MA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 S STATE ROAD 135 SUITE 110
GREENWOOD IN
46143-9607
US

IV. Provider business mailing address

3000 S STATE ROAD 135 SUITE 110
GREENWOOD IN
46143-9607
US

V. Phone/Fax

Practice location:
  • Phone: 317-535-4075
  • Fax: 317-535-4076
Mailing address:
  • Phone: 317-535-4075
  • Fax: 317-535-4076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22001138A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: