Provider Demographics
NPI:1578669438
Name:STEWART, MARK IRWIN (MS LP)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:IRWIN
Last Name:STEWART
Suffix:
Gender:M
Credentials:MS LP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2497 7TH AVE E
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2496
Mailing Address - Country:US
Mailing Address - Phone:651-769-6437
Mailing Address - Fax:651-769-6426
Practice Address - Street 1:7616 CURRELL BLVD
Practice Address - Street 2:SUITE 290
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-8204
Practice Address - Country:US
Practice Address - Phone:651-769-6550
Practice Address - Fax:651-769-6599
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNLP2568103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical