MEDICARE: LEWIS & CLARK INC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609934082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEWIS & CLARK INC

Provider Business Mailing Address
First Line	:	6512 SIX FORKS RD
Second Line	:	STE 203B
City	:	RALEIGH
State	:	NC
Zip	:	27615-6561
Country	:	US
Telephone Number	:	919-787-4400
Fax Number	:	919-341-1020

Provider Business Practice Location Address
First Line	:	6512 SIX FORKS RD
Second Line	:	STE 203B
City	:	RALEIGH
State	:	NC
Zip	:	27615-6561
Country	:	US
Telephone Number	:	919-787-4400
Fax Number	:	919-341-1020

Authorized Official
Title or Position	:	DIRECTOR OF SPEECH PATHOLOGY & SLP
Name	:	DOREEN ELIZABETH CLARK
Credential	:	MS CCC-SLP
Telephone Number	:	919-787-4400

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	03/01/2009

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Directions to “LEWIS & CLARK INC ” Practice Location

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