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General NPI Number Information
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NPI Number | 1245896455
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Entity Type | Individual
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Provider Name | KHEDEDRA RENEE LEWIS SLP
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Gender | Female
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Dates
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Enumeration Date | 05/13/2019
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Last Update Date | 05/13/2019
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Provider Practice Location Address
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Address Line | 1575 E WASHINGTON BLVD
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City | PASADENA
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State | CA
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Zip | 91104-2675
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Country | US
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Telephone | 626-317-0179
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Fax | 626-798-1647
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Provider Business Mailing Address
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Address Line | 300 E BELLEVUE DR APT 231
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City | PASADENA
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State | CA
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Zip | 91101-3106
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Country | US
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Telephone | 757-660-2784
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 25904
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License Number State | CA
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