Provider Demographics
NPI:1972803286
Name:STEWART, JAIMIE ALICE (BA,CDP)
Entity type:Individual
Prefix:MS
First Name:JAIMIE
Middle Name:ALICE
Last Name:STEWART
Suffix:
Gender:F
Credentials:BA,CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 203
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:WA
Mailing Address - Zip Code:98580-0203
Mailing Address - Country:US
Mailing Address - Phone:253-592-8140
Mailing Address - Fax:253-474-9724
Practice Address - Street 1:10828 GRAVELLY LAKE DR SW STE 204
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-1346
Practice Address - Country:US
Practice Address - Phone:253-473-7474
Practice Address - Fax:253-474-9724
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60167007101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)