MEDICARE: SONJA STEWART

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	273279	KY

General Provider Information

NPI Number	:	1215671847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONJA STEWART

Provider Business Mailing Address
First Line	:	10208 SUMMIT PARK PL APT 103
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40241-3885
Country	:	US
Telephone Number	:	601-826-9389
Fax Number	:

Provider Business Practice Location Address
First Line	:	11218 PROFESSIONAL PARK DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-4476
Country	:	US
Telephone Number	:	601-826-9389
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2022
Last Update Date	:	04/20/2022

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