Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY26070 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY26070 | CA |
NPI | 1003231283 |
---|---|
Provider Name | Dr. Wendy Lewis |
First Address | Roseville, CA 95661-3027 |
Second Address | Roseville, CA 95661-3027 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2014 |
Last Update Date | 03/01/2022 |