1740686906 NPI number — MRS. JAYLENE RAE STEWART (SPEECH PATHOLOGIST)

Table of content: MRS. JAYLENE RAE STEWART (SPEECH PATHOLOGIST) (NPI 1740686906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740686906 NPI number — MRS. JAYLENE RAE STEWART (SPEECH PATHOLOGIST)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEWART
Provider First Name:
JAYLENE
Provider Middle Name:
RAE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
(SPEECH PATHOLOGIST)
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEWART
Provider Other First Name:
JAYLENE
Provider Other Middle Name:
RAY
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1740686906
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
129 EAST COURT STREET, SHELBY COUNTY ANNEX
Provider Second Line Business Mailing Address:
MIDWEST REGIONAL EDUCATIONAL SERVICE CENTER
Provider Business Mailing Address City Name:
SIDNEY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-498-1354
Provider Business Mailing Address Fax Number:
937-498-4850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5300 HOUSTON RD.
Provider Second Line Business Practice Location Address:
HARDIN HOUSTON LOCAL SCHOOLS
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-295-3010
Provider Business Practice Location Address Fax Number:
937-295-3737
Provider Enumeration Date:
11/14/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SP.7173 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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