Healthcare Provider Details

I. General information

NPI: 1407394034
Provider Name (Legal Business Name): SAUNDRA WILLIS-STEWART LPN, CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 EATON AVE APT B
HAMILTON OH
45013-2959
US

IV. Provider business mailing address

217 EATON AVE APT B
HAMILTON OH
45013-2959
US

V. Phone/Fax

Practice location:
  • Phone: 513-341-0410
  • Fax: 513-805-3147
Mailing address:
  • Phone: 513-341-0410
  • Fax: 513-805-3147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number060796
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License NumberPN086984
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: