Healthcare Provider Details

I. General information

NPI: 1972727030
Provider Name (Legal Business Name): KIMBERLY STEWART SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 11/28/2025
Certification Date: 11/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 FRANK SCOTT PKWY W STE 824
BELLEVILLE IL
62223-5007
US

IV. Provider business mailing address

2810 FRANK SCOTT PKWY W STE 824
BELLEVILLE IL
62223-5007
US

V. Phone/Fax

Practice location:
  • Phone: 618-234-9705
  • Fax: 618-257-0665
Mailing address:
  • Phone: 618-234-9705
  • Fax: 618-257-0665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146004710
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2007006980
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: