Provider Demographics
NPI:1427464767
Name:STEWARD, KENDRA (MHS CCC-SLP)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:STEWARD
Suffix:
Gender:F
Credentials:MHS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3680 CHANNING AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-5163
Mailing Address - Country:US
Mailing Address - Phone:815-378-0405
Mailing Address - Fax:
Practice Address - Street 1:3680 CHANNING AVE
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-5163
Practice Address - Country:US
Practice Address - Phone:630-761-0900
Practice Address - Fax:630-761-0909
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.003101235Z00000X
FLSA 14599235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110677900Medicaid