Provider Demographics
NPI:1740797943
Name:STEWART, ELAINA (SLP)
Entity Type:Individual
Prefix:
First Name:ELAINA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ELAINA
Other - Middle Name:
Other - Last Name:PEETS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:7340 WATER VIEW LN
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-9656
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7340 WATER VIEW LN
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-9656
Practice Address - Country:US
Practice Address - Phone:616-202-2078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-09
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101005013235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1740797943Medicaid