Provider Demographics
NPI:1699221051
Name:STEWART, ALLISIA (MS, LPC-IT)
Entity Type:Individual
Prefix:
First Name:ALLISIA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:MS, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8311 N 107TH ST
Mailing Address - Street 2:UNIT H
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-2581
Mailing Address - Country:US
Mailing Address - Phone:270-303-5849
Mailing Address - Fax:
Practice Address - Street 1:8311 N 107TH ST
Practice Address - Street 2:UNIT H
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-2581
Practice Address - Country:US
Practice Address - Phone:270-303-5849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3197-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional