Provider Demographics
NPI:1336330760
Name:STEWART, JOHN (MS, FAAA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:STEWART
Suffix:
Gender:M
Credentials:MS, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 W 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4055
Mailing Address - Country:US
Mailing Address - Phone:405-372-2657
Mailing Address - Fax:405-372-2749
Practice Address - Street 1:129 W 7TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4055
Practice Address - Country:US
Practice Address - Phone:405-372-2657
Practice Address - Fax:405-372-2749
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK297237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter