Provider Demographics
NPI:1821794173
Name:STEWART, CORY D
Entity Type:Individual
Prefix:MR
First Name:CORY
Middle Name:D
Last Name:STEWART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 ROYALE CT
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-3400
Mailing Address - Country:US
Mailing Address - Phone:651-329-7544
Mailing Address - Fax:
Practice Address - Street 1:700 COMMERCE DR STE 255
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-5406
Practice Address - Country:US
Practice Address - Phone:651-714-3848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist