Provider Demographics
NPI:1164979829
Name:STEWART, ELLEN (MT-BC, ET, MA)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:MT-BC, ET, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SANRUE DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3642
Mailing Address - Country:US
Mailing Address - Phone:814-254-6215
Mailing Address - Fax:
Practice Address - Street 1:268 HOSTETLER RD
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3728
Practice Address - Country:US
Practice Address - Phone:814-259-6509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PA225A00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist