Mary Lee Lewis

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

S4467 Issued in MS

Practice address

6250 Old Canton Rd Ste 130
Jackson, MS 39211-2946

Phone

(601) 956-7280

Fax

(601) 977-6244

NPI assigned

May 29, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mary Lee Kennedy Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1559088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559088000000",
    "number": "1568029270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2153 DEPT 1947",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352870001",
            "telephone_number": "601-292-4562",
            "fax_number": "601-974-6237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6250 OLD CANTON RD STE 130",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392112946",
            "telephone_number": "601-956-7280",
            "fax_number": "601-977-6244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "MARY",
        "middle_name": "LEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-29",
        "last_updated": "2019-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MS",
            "license": "S4467",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "KENNEDY",
            "middle_name": "LEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kenyatta Lewis, LCSW
• Kever Anthony Lewis, MD
• Kimberly Clyde Lewis, NP-C
• Kyiesha Lewis
• Kyle Lewis, M. D.
• Patrick Tarrance Lewis, PA
• Samuel B. Lewis, DPT
• Sherry Shawonda Lewis
• Tara Clare Lewis, MD
• Virginia Denise Lewis, PMHNP

• Speech-Language Pathologist in Jackson, MS
• Providers in Jackson, MS by specialty
• Speech-Language Pathologist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.