Provider Demographics
NPI:1629299201
Name:STEWART-HURST, KORDELIA (MSCCCSLP)
Entity Type:Individual
Prefix:
First Name:KORDELIA
Middle Name:
Last Name:STEWART-HURST
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:KORDELIA
Other - Middle Name:
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSCCCSLP
Mailing Address - Street 1:P.O. BOX 585
Mailing Address - Street 2:
Mailing Address - City:PEA RIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:72751
Mailing Address - Country:US
Mailing Address - Phone:479-273-2345
Mailing Address - Fax:479-273-2345
Practice Address - Street 1:2705 SE G STREET, SUITE 1
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712
Practice Address - Country:US
Practice Address - Phone:479-273-2345
Practice Address - Fax:479-273-9391
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP1250235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U548Medicare UPIN