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General NPI Number Information
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NPI Number | 1912480153
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Entity Type | Individual
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Provider Name | NADINE M LEWIS LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/13/2018
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 1218 N DIVISION AVE STE 209
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City | SANDPOINT
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State | ID
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Zip | 83864-5054
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Country | US
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Telephone | 419-615-7861
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2186
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City | SANDPOINT
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State | ID
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Zip | 83864-0909
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Country | US
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Telephone | 419-615-7861
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-42816
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License Number State | ID
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