Provider Demographics
NPI:1073860862
Name:STEWART, MONIQUE CHRISTINE
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:CHRISTINE
Last Name: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 1:345 E 4500 S STE 260
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3954
Mailing Address - Country:US
Mailing Address - Phone:801-747-3556
Mailing Address - Fax:801-747-2086
Practice Address - Street 1:5720 S 900 E APT 1
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84121-1047
Practice Address - Country:US
Practice Address - Phone:801-293-0353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker