Provider Demographics
NPI:1740815208
Name:STEWART, KARISSA (BCBA)
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:19060 EVERETT BLVD UNIT 107
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-2500
Mailing Address - Country:US
Mailing Address - Phone:815-641-9187
Mailing Address - Fax:779-324-5236
Practice Address - Street 1:19060 EVERETT BLVD UNIT 107
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-2500
Practice Address - Country:US
Practice Address - Phone:815-641-9187
Practice Address - Fax:779-324-5236
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst