Provider Demographics
NPI:1720356710
Name:STEWART, KIMBERLY H (MA SLP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:H
Last Name:STEWART
Suffix:
Gender:F
Credentials:MA SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16019 CORNER LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32820-1934
Mailing Address - Country:US
Mailing Address - Phone:407-230-8895
Mailing Address - Fax:
Practice Address - Street 1:1850 LEE RD STE 134
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2104
Practice Address - Country:US
Practice Address - Phone:407-761-0561
Practice Address - Fax:407-622-4439
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12140235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist