Provider Demographics
NPI:1598540080
Name:STEWART, MATTIE LYNN (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:MATTIE
Middle Name:LYNN
Last Name:STEWART
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1992 W WAPOOT DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-2771
Mailing Address - Country:US
Mailing Address - Phone:208-695-4424
Mailing Address - Fax:
Practice Address - Street 1:1224 1ST ST S STE 300
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3963
Practice Address - Country:US
Practice Address - Phone:208-936-1097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID44092104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker