Provider Demographics
NPI:1144866492
Name:LEWIS, JACLYN (MA)
Entity type:Individual
Prefix:MS
First Name:JACLYN
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1324
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-0157
Mailing Address - Country:US
Mailing Address - Phone:458-895-4602
Mailing Address - Fax:
Practice Address - Street 1:233 E MAIN ST STE 401
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-5045
Practice Address - Country:US
Practice Address - Phone:571-365-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor