Provider Demographics
NPI:1871672709
Name:STEWART, AMY MICHELLE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:STEWART
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 REDBUD DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-4921
Mailing Address - Country:US
Mailing Address - Phone:580-323-0215
Mailing Address - Fax:580-323-8743
Practice Address - Street 1:1930 W GARY BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-3838
Practice Address - Country:US
Practice Address - Phone:580-323-8778
Practice Address - Fax:580-323-8743
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3136235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist