MEDICARE: PAMELA LEWIS M.A., 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	10845	CA

General Provider Information

NPI Number	:	1881027852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA LEWIS M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	104 VIA MALAGA
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92673-6704
Country	:	US
Telephone Number	:	714-501-1483
Fax Number	:	949-361-9178

Provider Business Practice Location Address
First Line	:	104 VIA MALAGA
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92673-6704
Country	:	US
Telephone Number	:	714-501-1483
Fax Number	:	949-361-9178

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

Provider Enumeration Date	:	08/14/2013
Last Update Date	:	08/14/2013

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