MEDICARE: MRS. JAYLENE RAE STEWART (SPEECH PATHOLOGIST)

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	SP.7173	OH

General Provider Information

NPI Number	:	1740686906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAYLENE RAE STEWART (SPEECH PATHOLOGIST)

Provider Business Mailing Address
First Line	:	129 EAST COURT STREET, SHELBY COUNTY ANNEX
Second Line	:	MIDWEST REGIONAL EDUCATIONAL SERVICE CENTER
City	:	SIDNEY
State	:	OH
Zip	:	45365
Country	:	US
Telephone Number	:	937-498-1354
Fax Number	:	937-498-4850

Provider Business Practice Location Address
First Line	:	5300 HOUSTON RD.
Second Line	:	HARDIN HOUSTON LOCAL SCHOOLS
City	:	HOUSTON
State	:	OH
Zip	:	45333
Country	:	US
Telephone Number	:	937-295-3010
Fax Number	:	937-295-3737

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

Provider Enumeration Date	:	11/14/2014
Last Update Date	:	01/31/2018

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