MEDICARE: MRS. DENISE PAGON LEWIS MA CCC/SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP-1330	NV

General Provider Information

NPI Number	:	1255514139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DENISE PAGON LEWIS MA CCC/SLP

Provider Business Mailing Address
First Line	:	6736 RAINSTORM RIDGE AVENUE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131
Country	:	US
Telephone Number	:	702-375-8805
Fax Number	:

Provider Business Practice Location Address
First Line	:	6736 RAINSTORM RIDGE AVENUE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131
Country	:	US
Telephone Number	:	702-375-8805
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2007
Last Update Date	:	08/13/2012

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