Provider Demographics
NPI:1942513668
Name:STEWART, JODI MICHELLE (MED)
Entity Type:Individual
Prefix:MS
First Name:JODI
Middle Name:MICHELLE
Last Name:STEWART
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11756 SOUTH AVE
Mailing Address - Street 2:P.O. BOX 50
Mailing Address - City:NORTH LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:44452-8556
Mailing Address - Country:US
Mailing Address - Phone:330-727-0040
Mailing Address - Fax:
Practice Address - Street 1:11756 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:NORTH LIMA
Practice Address - State:OH
Practice Address - Zip Code:44452-8556
Practice Address - Country:US
Practice Address - Phone:330-727-0040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0800483101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional