Basic Information
| Provider Information | |||||||||
| NPI: | 1063937464 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEWART | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.S., SLP-CFY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 S FESTIVAL DR | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799125801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9158421788 | ||||||||
| FaxNumber: | 9158421778 | ||||||||
| Practice Location | |||||||||
| Address1: | 109 S FESTIVAL DR | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799125801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9158421788 | ||||||||
| FaxNumber: | 9158421778 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 113091 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 113091 | 01 | TX | LICENSE | OTHER | C6166 | 01 | NM | LICENSE | OTHER |