Provider Demographics
NPI:1316790637
Name:DR KIM STEWART LLC
Entity type:Organization
Organization Name:DR KIM STEWART LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP, LAMFT
Authorized Official - Phone:612-812-0992
Mailing Address - Street 1:2626 E 82ND ST STE 225B
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1301
Mailing Address - Country:US
Mailing Address - Phone:612-812-0992
Mailing Address - Fax:612-778-1635
Practice Address - Street 1:2626 E 82ND ST STE 225B
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-1301
Practice Address - Country:US
Practice Address - Phone:612-812-0992
Practice Address - Fax:612-778-1635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty