Healthcare Provider Details

I. General information

NPI: 1679873202
Provider Name (Legal Business Name): COLLEEN DAWN LEWIS CA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2010
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 JEFFERSON STREET
SPRING GREEN WI
53588
US

IV. Provider business mailing address

S7610 CHAPEL LN
HILLPOINT WI
53937-9776
US

V. Phone/Fax

Practice location:
  • Phone: 608-220-4489
  • Fax:
Mailing address:
  • Phone: 608-220-4489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number315055
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: