Provider Demographics
NPI:1841445319
Name:STEWART, JUDY (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 INDIAN MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06039-2028
Mailing Address - Country:US
Mailing Address - Phone:860-671-9204
Mailing Address - Fax:860-435-5033
Practice Address - Street 1:211 INDIAN MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:CT
Practice Address - Zip Code:06039-2028
Practice Address - Country:US
Practice Address - Phone:860-671-9204
Practice Address - Fax:860-435-5033
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010037-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist