Provider Demographics
NPI:1235246422
Name:STEWART, PATRICIA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:PATRICIA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 SUNSET RD
Mailing Address - Street 2:
Mailing Address - City:WEST READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-1345
Mailing Address - Country:US
Mailing Address - Phone:610-374-6014
Mailing Address - Fax:610-374-6014
Practice Address - Street 1:396 SUNSET RD
Practice Address - Street 2:
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1345
Practice Address - Country:US
Practice Address - Phone:610-374-6014
Practice Address - Fax:610-374-6014
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007455235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012599550001Medicaid