Provider Demographics
NPI:1912371303
Name:STEWART, MIRELLA ANGELIA (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MIRELLA
Middle Name:ANGELIA
Last Name:STEWART
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:MIRELLA
Other - Middle Name:ANGELIA
Other - Last Name:RHAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:6610 SAINT ANDREWS CROSS APT E
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-1179
Mailing Address - Country:US
Mailing Address - Phone:513-306-1548
Mailing Address - Fax:
Practice Address - Street 1:6610 SAINT ANDREWS CROSS APT E
Practice Address - Street 2:
Practice Address - City:LIBERTY TWP
Practice Address - State:OH
Practice Address - Zip Code:45044-1179
Practice Address - Country:US
Practice Address - Phone:513-306-1548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-23
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 11883235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2187155Medicaid
OHAB7360731Medicare PIN