MEDICARE: KENDRA STEWARD MHS CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	242.003101	IL
2	235Z00000X	Speech-Language Pathologist	SA 14599	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427464767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA STEWARD MHS CCC-SLP

Provider Business Mailing Address
First Line	:	3680 CHANNING AVE
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34287-5163
Country	:	US
Telephone Number	:	815-378-0405
Fax Number	:

Provider Business Practice Location Address
First Line	:	3680 CHANNING AVE
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34287-5163
Country	:	US
Telephone Number	:	630-761-0900
Fax Number	:	630-761-0909

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2014
Last Update Date	:	02/10/2022

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Directions to “ KENDRA STEWARD MHS CCC-SLP” Practice Location

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