Provider Demographics
NPI:1588100283
Name:STEWART, KALYNN ALEXANDRA (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KALYNN
Middle Name:ALEXANDRA
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 1:7 LUIZ CT
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1099
Mailing Address - Country:US
Mailing Address - Phone:415-328-1978
Mailing Address - Fax:
Practice Address - Street 1:7 LUIZ CT
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1099
Practice Address - Country:US
Practice Address - Phone:415-328-1978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11037235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist