Provider Demographics
NPI:1205487691
Name:STEWART, VALERIE
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
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 1:3801 MCKELVEY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-4075
Mailing Address - Country:US
Mailing Address - Phone:314-761-1732
Mailing Address - Fax:636-757-3428
Practice Address - Street 1:3801 MCKELVEY RD STE 101
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-4075
Practice Address - Country:US
Practice Address - Phone:314-761-1732
Practice Address - Fax:636-757-3428
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001662927251E00000X
MOLC001662927251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health