Provider Demographics
NPI:1912114703
Name:STEWART, BONNIE JEAN (CDS)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:JEAN
Last Name:STEWART
Suffix:
Gender:F
Credentials:CDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20552 BLUESTEM PKWY
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60411-8549
Mailing Address - Country:US
Mailing Address - Phone:708-507-5511
Mailing Address - Fax:708-757-7145
Practice Address - Street 1:20552 BLUESTEM PKWY
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60411-8549
Practice Address - Country:US
Practice Address - Phone:708-507-5511
Practice Address - Fax:708-757-7145
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist