Healthcare Provider Details

I. General information

NPI: 1336276831
Provider Name (Legal Business Name): REBECCA LYNN STEWART MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 02/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3690 N MOUNT JULIET RD STE 400
MOUNT JULIET TN
37122-3182
US

IV. Provider business mailing address

2221 DOMINICK DR
NOLENSVILLE TN
37135-5025
US

V. Phone/Fax

Practice location:
  • Phone: 615-758-4888
  • Fax:
Mailing address:
  • Phone: 502-553-0132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4205
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: