Provider Demographics
NPI:1740686906
Name:STEWART, JAYLENE RAE ((SPEECH PATHOLOGIST))
Entity type:Individual
Prefix:MRS
First Name:JAYLENE
Middle Name:RAE
Last Name:STEWART
Suffix:
Gender:F
Credentials:(SPEECH PATHOLOGIST)
Other - Prefix:MRS
Other - First Name:JAYLENE
Other - Middle Name:RAY
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:129 EAST COURT STREET, SHELBY COUNTY ANNEX
Mailing Address - Street 2:MIDWEST REGIONAL EDUCATIONAL SERVICE CENTER
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365
Mailing Address - Country:US
Mailing Address - Phone:937-498-1354
Mailing Address - Fax:937-498-4850
Practice Address - Street 1:5300 HOUSTON RD.
Practice Address - Street 2:HARDIN HOUSTON LOCAL SCHOOLS
Practice Address - City:HOUSTON
Practice Address - State:OH
Practice Address - Zip Code:45333
Practice Address - Country:US
Practice Address - Phone:937-295-3010
Practice Address - Fax:937-295-3737
Is Sole Proprietor?:No
Enumeration Date:2014-11-14
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.7173235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist