Provider Demographics
NPI:1215281605
Name:STEWART, COLLEEN ANN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:ANN
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 1:536 INWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-2820
Mailing Address - Country:US
Mailing Address - Phone:615-482-0002
Mailing Address - Fax:
Practice Address - Street 1:9129 MONROE RD
Practice Address - Street 2:SUITE 100-105
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-2429
Practice Address - Country:US
Practice Address - Phone:704-847-3911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9968235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist