Healthcare Provider Details

I. General information

NPI: 1548123730
Provider Name (Legal Business Name): DAIJA STEWART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5348 S VERDE
MESA AZ
85212-9116
US

IV. Provider business mailing address

11675 N SIDERS LN
MARICOPA AZ
85139-5718
US

V. Phone/Fax

Practice location:
  • Phone: 616-308-2017
  • Fax:
Mailing address:
  • Phone: 916-271-5133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA16637
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: