Healthcare Provider Details

I. General information

NPI: 1891975397
Provider Name (Legal Business Name): DAWN M STEWART MS, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 S GREER ST
MEMPHIS TN
38111-3434
US

IV. Provider business mailing address

214 S GREER ST
MEMPHIS TN
38111-3434
US

V. Phone/Fax

Practice location:
  • Phone: 901-849-6433
  • Fax:
Mailing address:
  • Phone: 901-849-6433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberBCBA #: 1-07-3269
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0000000078
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: