Provider Demographics
NPI:1679580328
Name:LEWIS, CHRISTINE S (LISW ACSW MSW)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:S
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LISW ACSW MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 INGERSOLL AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312
Mailing Address - Country:US
Mailing Address - Phone:515-279-2834
Mailing Address - Fax:515-279-4168
Practice Address - Street 1:3209 INGERSOLL AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312
Practice Address - Country:US
Practice Address - Phone:515-279-2834
Practice Address - Fax:515-279-4168
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA531104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI14480Medicare ID - Type Unspecified