Provider Demographics
NPI:1922292135
Name:STEWART, BONNY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BONNY
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11413
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-0007
Mailing Address - Country:US
Mailing Address - Phone:480-248-3922
Mailing Address - Fax:480-282-4363
Practice Address - Street 1:2730 S VAL VISTA DR
Practice Address - Street 2:BLDG.7, SUITE 135
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1675
Practice Address - Country:US
Practice Address - Phone:480-248-3922
Practice Address - Fax:480-282-4363
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3852103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical