Healthcare Provider Details

I. General information

NPI: 1962668525
Provider Name (Legal Business Name): KENDRA RAY STEWART PH.D., HSPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 ESKENAZI AVE
INDIANAPOLIS IN
46202-5166
US

IV. Provider business mailing address

720 ESKENAZI AVE FIFTH THIRD BANK BLDG, 5TH FL
INDIANAPOLIS IN
46202-5166
US

V. Phone/Fax

Practice location:
  • Phone: 317-880-7666
  • Fax: 317-880-0448
Mailing address:
  • Phone: 317-880-4121
  • Fax: 317-880-0343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20042128A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: