Provider Demographics
NPI:1952816852
Name:EWART, ANTAINETTE
Entity Type:Individual
Prefix:
First Name:ANTAINETTE
Middle Name:
Last Name:EWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6173 RALEIGH ST APT 1704
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-2296
Mailing Address - Country:US
Mailing Address - Phone:407-272-1984
Mailing Address - Fax:
Practice Address - Street 1:1701 PARK CENTER DR STE 230
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6235
Practice Address - Country:US
Practice Address - Phone:321-445-1287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-13
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL61092355S0801X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician