Healthcare Provider Details

I. General information

NPI: 1881138659
Provider Name (Legal Business Name): KIAYONNA LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2016
Last Update Date: 02/08/2026
Certification Date: 02/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 TROY ST
DAYTON OH
45404-1852
US

IV. Provider business mailing address

1802 BALTIMORE AVE
CINCINNATI OH
45225-1903
US

V. Phone/Fax

Practice location:
  • Phone: 937-982-1500
  • Fax: 937-982-1500
Mailing address:
  • Phone: 513-373-8980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number156413
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: