Provider Demographics
NPI:1407394034
Name:WILLIS-STEWART, SAUNDRA (LPN, CDCA)
Entity Type:Individual
Prefix:MRS
First Name:SAUNDRA
Middle Name:
Last Name:WILLIS-STEWART
Suffix:
Gender:F
Credentials:LPN, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 EATON AVE APT B
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-2959
Mailing Address - Country:US
Mailing Address - Phone:513-341-0410
Mailing Address - Fax:513-805-3147
Practice Address - Street 1:217 EATON AVE APT B
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-2959
Practice Address - Country:US
Practice Address - Phone:513-341-0410
Practice Address - Fax:513-805-3147
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH060796101YA0400X
OHPN086984374T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)