Provider Demographics
NPI:1184933244
Name:STEWART-NGARUIYA, ARISA (M ED CCC-SLP)
Entity type:Individual
Prefix:
First Name:ARISA
Middle Name:
Last Name:STEWART-NGARUIYA
Suffix:
Gender:F
Credentials:M ED CCC-SLP
Other - Prefix:
Other - First Name:ARISA
Other - Middle Name:
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:M ED CCC-SLP
Mailing Address - Street 1:15 PERRY ST # 399
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-1918
Mailing Address - Country:US
Mailing Address - Phone:470-668-0229
Mailing Address - Fax:
Practice Address - Street 1:2580 SUMMER LAKE RD
Practice Address - Street 2:#9402
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-3839
Practice Address - Country:US
Practice Address - Phone:225-773-1634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-06
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006070235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003201757Medicaid