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NPI Code Detail

MEDICARE: MARIA STEWART PSYD

MEDICARE:   MARIA  STEWART  PSYD
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
1103TC2200XClinical Child & Adolescent Psychologist071005206IL
2235Z00000XSpeech-Language Pathologist146001511IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
104922024OTHERILBCBS PT
22222567OTHERILBCBS SP

General Provider Information

NPI Number : 1669535456
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA STEWART PSYD
Provider Business Mailing Address
First Line : 707 RIDGEVIEW ST
Second Line :
City : DOWNERS GROVE
State : IL
Zip : 60516-3930
Country : US
Telephone Number : 630-852-7336
Fax Number : 630-852-8177
Provider Business Practice Location Address
First Line : 1047 S YORK RD
Second Line :
City : ELMHURST
State : IL
Zip : 60126-5121
Country : US
Telephone Number : 630-852-7336
Fax Number : 630-852-8177
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2006
Last Update Date : 05/23/2008

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