MEDICARE: STEPHANIE NICOLE STEWART MA, LPCC

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	101YP2500X	Professional Counselor	CC02257	MN

General Provider Information

NPI Number	:	1417540592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE NICOLE STEWART MA, LPCC

Provider Business Mailing Address
First Line	:	1370 MENDOTA HEIGHTS RD
Second Line	:
City	:	MENDOTA HEIGHTS
State	:	MN
Zip	:	55120-1281
Country	:	US
Telephone Number	:	651-313-8080
Fax Number	:

Provider Business Practice Location Address
First Line	:	4150 OLSON MEMORIAL HWY STE 110
Second Line	:
City	:	GOLDEN VALLEY
State	:	MN
Zip	:	55422-4811
Country	:	US
Telephone Number	:	651-313-8080
Fax Number	:

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

Provider Enumeration Date	:	02/18/2021
Last Update Date	:	12/05/2023

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