Provider Demographics
NPI:1649334772
Name:STEWART, KRISTA ROSE (DT)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:ROSE
Last Name:STEWART
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 NORTHAMPTON DR APT C1
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-4359
Mailing Address - Country:US
Mailing Address - Phone:224-805-9116
Mailing Address - Fax:
Practice Address - Street 1:3105 N WILKE RD STE H
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1450
Practice Address - Country:US
Practice Address - Phone:847-255-8690
Practice Address - Fax:284-255-2260
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist