Healthcare Provider Details

I. General information

NPI: 1356269823
Provider Name (Legal Business Name): JAYCI STEWART SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 CONSTITUTION DR STE 102
SPRINGFIELD IL
62704-6728
US

IV. Provider business mailing address

3221 GERMAN RD
WAVERLY IL
62692-6069
US

V. Phone/Fax

Practice location:
  • Phone: 217-500-8203
  • Fax:
Mailing address:
  • Phone: 217-473-7078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242008571
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: