Provider Demographics
NPI:1245464908
Name:STEWART, SANTINA MARIE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:SANTINA
Middle Name:MARIE
Last Name:STEWART
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BETHLEHEM CT
Mailing Address - Street 2:CIRCLE OF FRIENDS
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-1306
Mailing Address - Country:US
Mailing Address - Phone:518-478-0722
Mailing Address - Fax:518-478-0827
Practice Address - Street 1:2 BETHLEHEM CT
Practice Address - Street 2:CIRCLE OF FRIENDS
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-1306
Practice Address - Country:US
Practice Address - Phone:518-478-0722
Practice Address - Fax:518-478-0827
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018881235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist