MEDICARE: CATHERINE LEWIS 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	146.012512	IL

General Provider Information

NPI Number	:	1720466253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE LEWIS CCC-SLP

Provider Business Mailing Address
First Line	:	5707 S MASON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-3606
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5707 S MASON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-3606
Country	:	US
Telephone Number	:	773-405-3926
Fax Number	:

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

Provider Enumeration Date	:	05/17/2015
Last Update Date	:	08/12/2020

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Directions to “ CATHERINE LEWIS CCC-SLP” Practice Location

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