Provider Demographics
NPI:1235027095
Name:STEWART, KIMBERLY (MS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 E WISCONSIN ST STE 206
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-2455
Mailing Address - Country:US
Mailing Address - Phone:608-697-6528
Mailing Address - Fax:608-999-7357
Practice Address - Street 1:311 E WISCONSIN ST STE 206
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-2455
Practice Address - Country:US
Practice Address - Phone:608-697-6528
Practice Address - Fax:608-999-7357
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator