Provider Demographics
NPI:1073085866
Name:BLANK-STEWART, OLIVIA MARIE
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MARIE
Last Name:BLANK-STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1952 MC DOWELL RD
Mailing Address - Street 2:STE 305
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-6507
Mailing Address - Country:US
Mailing Address - Phone:630-689-1022
Mailing Address - Fax:630-689-1023
Practice Address - Street 1:1952 MC DOWELL RD
Practice Address - Street 2:STE 305
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-6507
Practice Address - Country:US
Practice Address - Phone:630-689-1022
Practice Address - Fax:630-689-1023
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-18
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL203181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical