Provider Demographics
NPI:1275420739
Name:STEWART, TESSA ANN
Entity type:Individual
Prefix:MISS
First Name:TESSA
Middle Name:ANN
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TESSA
Other - Middle Name:ANN
Other - Last Name:HAIGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24525 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2740
Mailing Address - Country:US
Mailing Address - Phone:231-412-1582
Mailing Address - Fax:
Practice Address - Street 1:24525 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2740
Practice Address - Country:US
Practice Address - Phone:231-412-1582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician