Healthcare Provider Details

I. General information

NPI: 1124049556
Provider Name (Legal Business Name): ROXANNE ANGELA LEWIS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E CAMPUS VIEW BLVD SUITE 200
COLUMBUS OH
43235-4678
US

IV. Provider business mailing address

387 COUNTY LINE RD W STE 225
WESTERVILLE OH
43082-6918
US

V. Phone/Fax

Practice location:
  • Phone: 614-985-3649
  • Fax: 614-985-3601
Mailing address:
  • Phone: 614-985-3649
  • Fax: 614-985-3601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3428
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3574
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number60009283
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: