Healthcare Provider Details

I. General information

NPI: 1871477695
Provider Name (Legal Business Name): JENNIFER LYN STEWART
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3721 NE TROON DR
LEES SUMMIT MO
64064-1988
US

IV. Provider business mailing address

PO BOX 844383
DALLAS TX
75284-4383
US

V. Phone/Fax

Practice location:
  • Phone: 816-221-0305
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2024043291
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: