Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 2002011104 | MO |
NPI | 1073706008 |
---|---|
Provider Name | Gwin Michelle Stewart |
First Address | Saint Louis, MO 63119-1833 |
Second Address | Saint Louis, MO 63119-1833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2007 |
Last Update Date | 04/10/2007 |