Provider Demographics
NPI:1538503644
Name:STEWART, JOHNNA (LICSW)
Entity Type:Individual
Prefix:
First Name:JOHNNA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 191ST PL SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5077
Mailing Address - Country:US
Mailing Address - Phone:425-431-2758
Mailing Address - Fax:425-431-7363
Practice Address - Street 1:7200 191ST PL SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5077
Practice Address - Country:US
Practice Address - Phone:425-431-2758
Practice Address - Fax:425-431-7363
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000064171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical