Healthcare Provider Details

I. General information

NPI: 1154367589
Provider Name (Legal Business Name): LINDA DEAN LEWIS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BROAD ROCK BLVD AUDIOLOGY & SPEECH PATHOLOGY SERVICE
RICHMOND VA
23249-0001
US

IV. Provider business mailing address

14312 COVE RIDGE PL
MIDLOTHIAN VA
23112-4337
US

V. Phone/Fax

Practice location:
  • Phone: 804-675-5000
  • Fax: 804-675-5440
Mailing address:
  • Phone: 804-744-8808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2201000070
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: