Provider Demographics
NPI:1184276412
Name:STEWART, KRISTINA (BCABA)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:STEWART
Suffix:
Gender:
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 S HALLECK ST
Mailing Address - Street 2:
Mailing Address - City:DEMOTTE
Mailing Address - State:IN
Mailing Address - Zip Code:46310-8342
Mailing Address - Country:US
Mailing Address - Phone:812-550-3197
Mailing Address - Fax:
Practice Address - Street 1:4900 SHAMROCK DR STE 205A
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-7395
Practice Address - Country:US
Practice Address - Phone:812-550-3197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst