Provider Demographics
NPI:1114269487
Name:STEWART, TERRI STUTTS (SLP)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:STUTTS
Last Name:STEWART
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 SANDE HILL PL
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-0310
Mailing Address - Country:US
Mailing Address - Phone:706-721-5223
Mailing Address - Fax:706-721-5228
Practice Address - Street 1:1206 SANDE HILL PL
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-0310
Practice Address - Country:US
Practice Address - Phone:706-721-5223
Practice Address - Fax:706-721-5228
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005224235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist