Provider Demographics
NPI:1770836538
Name:STEWART, ELIZABETH A (MS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:STEWART
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PIEDRA LOOP
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-3827
Mailing Address - Country:US
Mailing Address - Phone:505-672-1060
Mailing Address - Fax:
Practice Address - Street 1:111 PIEDRA LOOP
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-3827
Practice Address - Country:US
Practice Address - Phone:505-672-1060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM011235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist