Provider Demographics
NPI:1619286416
Name:STEWART, AMANDA EDWARDS (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:EDWARDS
Last Name:STEWART
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:RACHEL
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:MADIGAN ARMY MEDICAL CTR
Mailing Address - Street 2:9040 JACKSON AVE ATTN: CREDENTIALS
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-1100
Mailing Address - Country:US
Mailing Address - Phone:253-968-1290
Mailing Address - Fax:253-968-4192
Practice Address - Street 1:MADIGAN ARMY MEDICAL CTR
Practice Address - Street 2:ATTN: CREDENTIALS
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1100
Practice Address - Country:US
Practice Address - Phone:253-968-3287
Practice Address - Fax:253-968-4192
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
WAPY60141928103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA911636568Medicaid
WAVAD000Medicare UPIN