Provider Demographics
NPI:1700567146
Name:STEWARD, KATHRYN ELIZABETH LEILA
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ELIZABETH LEILA
Last Name:STEWARD
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 1:1227 PANORAMIC LOOP
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-7008
Mailing Address - Country:US
Mailing Address - Phone:425-463-7881
Mailing Address - Fax:
Practice Address - Street 1:1227 PANORAMIC LOOP
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-7008
Practice Address - Country:US
Practice Address - Phone:425-463-7881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARBT-23-292013106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician