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General NPI Number Information
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NPI Number | 1902515042
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Entity Type | Individual
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Provider Name | GWENDOLEN LEWIS
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Gender | Female
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Dates
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Enumeration Date | 11/17/2022
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 21416 PROVINCIAL BLVD
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City | KATY
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State | TX
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Zip | 77450-7587
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Country | US
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Telephone | 281-769-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 1547 30TH AVE S
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City | MOORHEAD
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State | MN
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Zip | 56560-5149
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Country | US
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Telephone |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-23-294566
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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