Healthcare Provider Details

I. General information

NPI: 1588998595
Provider Name (Legal Business Name): LAURA JEAN LEWIS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3454 OAK ALLEY CT STE 200
TOLEDO OH
43606-1370
US

IV. Provider business mailing address

3454 OAK ALLEY CT STE 200
TOLEDO OH
43606-1370
US

V. Phone/Fax

Practice location:
  • Phone: 419-460-0413
  • Fax: 844-443-0075
Mailing address:
  • Phone: 419-460-0413
  • Fax: 844-443-0075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberE 0004386
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6498
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number180943
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: