Healthcare Provider Details

I. General information

NPI: 1477316446
Provider Name (Legal Business Name): MARY CHARLENE STEWART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2024
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 S ASH ST
BUFFALO MO
65622-9311
US

IV. Provider business mailing address

1323 S ASH ST
BUFFALO MO
65622-9311
US

V. Phone/Fax

Practice location:
  • Phone: 417-345-2222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: