Healthcare Provider Details

I. General information

NPI: 1316744717
Provider Name (Legal Business Name): LEAH LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35425 W MICHIGAN AVE STE 3693
WAYNE MI
48184-1668
US

IV. Provider business mailing address

17530 FAIRWAY DR
DETROIT MI
48221-2705
US

V. Phone/Fax

Practice location:
  • Phone: 734-467-7600
  • Fax:
Mailing address:
  • Phone: 313-805-7975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number83656
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: