Healthcare Provider Details

I. General information

NPI: 1265753685
Provider Name (Legal Business Name): SUSAN VERONICA STEWART CCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 WEMBLEY CT
ALBANY NY
12205-3851
US

IV. Provider business mailing address

414 SANDERS AVE
SCOTIA NY
12302-1732
US

V. Phone/Fax

Practice location:
  • Phone: 518-464-6302
  • Fax:
Mailing address:
  • Phone: 518-374-9802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number004208
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: