Provider Demographics
NPI:1952085987
Name:STEWART, CARLA JO
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:JO
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IL
Mailing Address - Zip Code:61727-2411
Mailing Address - Country:US
Mailing Address - Phone:217-521-6763
Mailing Address - Fax:
Practice Address - Street 1:401 CEDAR DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IL
Practice Address - Zip Code:61727-2411
Practice Address - Country:US
Practice Address - Phone:217-521-6763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical