Provider Demographics
NPI:1013320829
Name:LEWIS, SUZETTE (PSY D)
Entity type:Individual
Prefix:
First Name:SUZETTE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 ABBOTT RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-4450
Mailing Address - Country:US
Mailing Address - Phone:907-522-7080
Mailing Address - Fax:907-522-7088
Practice Address - Street 1:2121 ABBOTT RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-4450
Practice Address - Country:US
Practice Address - Phone:907-522-7080
Practice Address - Fax:907-522-7088
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK109776103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist