Provider Demographics
NPI:1063766608
Name:STEWART, KATHRYN L (MA)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:L
Last Name:STEWART
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8778 N RECREATION AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3959
Mailing Address - Country:US
Mailing Address - Phone:559-297-1588
Mailing Address - Fax:
Practice Address - Street 1:3351 M ST STE 205
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2731
Practice Address - Country:US
Practice Address - Phone:209-724-0501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1654231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist