Healthcare Provider Details

I. General information

NPI: 1104756550
Provider Name (Legal Business Name): KATRINA STEWART M.ED., RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W MAPLE ST
CLARENCE MO
63437-1728
US

IV. Provider business mailing address

314 E 3RD ST
SALISBURY MO
65281-1375
US

V. Phone/Fax

Practice location:
  • Phone: 660-651-4051
  • Fax:
Mailing address:
  • Phone: 660-676-4606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1330243
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: