Provider Demographics
NPI:1154567634
Name:STEWART, NICOLE ARBUTUS (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:ARBUTUS
Last Name:STEWART
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13116 BORGMAN AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1004
Mailing Address - Country:US
Mailing Address - Phone:248-752-8467
Mailing Address - Fax:
Practice Address - Street 1:13116 BORGMAN AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1004
Practice Address - Country:US
Practice Address - Phone:248-752-8467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7282235Z00000X
MI7101004586235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist