Provider Demographics
NPI:1124581467
Name:STEWART, ALISON (BA, BS, CMII)
Entity Type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:BA, BS, CMII
Other - Prefix:MISS
Other - First Name:ALISON
Other - Middle Name:
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, BS, CMII
Mailing Address - Street 1:6210 NBU
Mailing Address - Street 2:
Mailing Address - City:PRAGUE
Mailing Address - State:OK
Mailing Address - Zip Code:74864-2511
Mailing Address - Country:US
Mailing Address - Phone:405-687-1303
Mailing Address - Fax:
Practice Address - Street 1:112 MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:OK
Practice Address - Zip Code:74834-1622
Practice Address - Country:US
Practice Address - Phone:405-258-3040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OK261QM0801X171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator