Provider Demographics
NPI:1700105418
Name:HAZARD, STUART WILLIAM (LP)
Entity type:Individual
Prefix:MR
First Name:STUART
Middle Name:WILLIAM
Last Name:HAZARD
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33861 RIVERSIDE DR NE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:55008-7712
Mailing Address - Country:US
Mailing Address - Phone:763-689-3833
Mailing Address - Fax:
Practice Address - Street 1:33861 RIVERSIDE DR NE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-7712
Practice Address - Country:US
Practice Address - Phone:763-689-3833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5081103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist