Provider Demographics
NPI:1013675347
Name:STEWARD, MADDISON
Entity Type:Individual
Prefix:
First Name:MADDISON
Middle Name:
Last Name:STEWARD
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 1:5341 METOYER CT
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-8446
Mailing Address - Country:US
Mailing Address - Phone:317-414-2806
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:6925 PARKDALE PL
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-4673
Practice Address - Country:US
Practice Address - Phone:317-597-4553
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2021-12-03
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-21-195161106S00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician