Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 6801095549 | MI |
NPI | 1003237710 |
---|---|
Provider Name | Heather Stewart |
First Address | Port Huron, MI 48060-8127 |
Second Address | Port Huron, MI 48060-8127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2013 |
Last Update Date | 29/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003237710 | (05) | MI |