Provider Demographics
NPI:1538953286
Name:STEWART, ANTONIA ISABEL (HIS)
Entity type:Individual
Prefix:MS
First Name:ANTONIA
Middle Name:ISABEL
Last Name:STEWART
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:MS
Other - First Name:ANTONIA
Other - Middle Name:ISABEL
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:541 SE FORD ST APT 4
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-6133
Mailing Address - Country:US
Mailing Address - Phone:719-644-5384
Mailing Address - Fax:
Practice Address - Street 1:325 NE BAKER CREEK RD
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-2019
Practice Address - Country:US
Practice Address - Phone:503-472-5554
Practice Address - Fax:503-474-0998
Is Sole Proprietor?:No
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10254462237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist