Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 109776 | AK |
Y | 103T00000X | Psychologist | 109776 | AK |
NPI | 1013320829 |
---|---|
Provider Name | Suzette Lewis |
First Address | Anchorage, AK 99507-5391 |
Second Address | Anchorage, AK 99507-5391 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2014 |
Last Update Date | 10/05/2016 |