Provider Demographics
NPI:1205141298
Name:STEWART, HEIDI R
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:R
Last Name:STEWART
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 1:4330 VILLAGE DR
Mailing Address - Street 2:UNIT C
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-2848
Mailing Address - Country:US
Mailing Address - Phone:561-302-3204
Mailing Address - Fax:561-499-0071
Practice Address - Street 1:160 NW 4TH ST
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-3826
Practice Address - Country:US
Practice Address - Phone:561-391-8444
Practice Address - Fax:561-391-6823
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2010-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ4869235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist