Provider Demographics
NPI:1740165786
Name:STEWART, JENNIFER (MS, PPS, CWA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:MS, PPS, CWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 S HALCYON RD
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-6539
Mailing Address - Country:US
Mailing Address - Phone:805-474-3400
Mailing Address - Fax:
Practice Address - Street 1:2555 S HALCYON RD
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-6539
Practice Address - Country:US
Practice Address - Phone:805-474-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA359EF150AD171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach