Provider Demographics
NPI:1447760194
Name:STEWARD, AMANDA KRISTINE (CTRS, CADC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KRISTINE
Last Name:STEWARD
Suffix:
Gender:F
Credentials:CTRS, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5875 FLEUR DR
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50321-2883
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:515-864-0217
Practice Address - Street 1:5875 FLEUR DR
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50321-2883
Practice Address - Country:US
Practice Address - Phone:888-788-5833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA13080101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)