MEDICARE: MARY CHARLENE STEWART

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	2355S0801X	Speech-Language Assistant

General Provider Information

NPI Number	:	1477316446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY CHARLENE STEWART

Provider Business Mailing Address
First Line	:	1323 S ASH ST
Second Line	:
City	:	BUFFALO
State	:	MO
Zip	:	65622-9311
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1323 S ASH ST
Second Line	:
City	:	BUFFALO
State	:	MO
Zip	:	65622-9311
Country	:	US
Telephone Number	:	417-345-2222
Fax Number	:

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

Provider Enumeration Date	:	02/02/2024
Last Update Date	:	02/02/2024

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Directions to “ MARY CHARLENE STEWART ” Practice Location

Language	Start Address	Practice Location

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