Provider Demographics
NPI:1285801118
Name:STEWART, DAVID (AUD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:STEWART
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2923 WEBSTER ST STE 201
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3418
Mailing Address - Country:US
Mailing Address - Phone:408-472-5658
Mailing Address - Fax:
Practice Address - Street 1:2923 WEBSTER ST STE 201
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3418
Practice Address - Country:US
Practice Address - Phone:510-752-8330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2683231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU2683OtherCALIFORNIA STATE AUDIOLOGY LICENSE