Provider Demographics
NPI:1639632383
Name:STEWART, CINDY (SAC-IT)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-0068
Mailing Address - Country:US
Mailing Address - Phone:715-233-1035
Mailing Address - Fax:715-235-2688
Practice Address - Street 1:24248 STATE ROAD 35 70 STE D
Practice Address - Street 2:
Practice Address - City:SIREN
Practice Address - State:WI
Practice Address - Zip Code:54872-5002
Practice Address - Country:US
Practice Address - Phone:715-349-7233
Practice Address - Fax:715-349-7205
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18838-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)