Provider Demographics
NPI:1205650470
Name:STEWART, SIMANTHA (LCSW)
Entity type:Individual
Prefix:
First Name:SIMANTHA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 78
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:WY
Mailing Address - Zip Code:83119-0078
Mailing Address - Country:US
Mailing Address - Phone:307-887-0139
Mailing Address - Fax:
Practice Address - Street 1:296 W ANTELOPE DR APT O
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-6081
Practice Address - Country:US
Practice Address - Phone:307-887-0139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13296509-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical