Provider Demographics
NPI:1679132674
Name:STEWART, ALEXIS ANN (BS)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ANN
Last Name:STEWART
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 STEIN BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-2674
Mailing Address - Country:US
Mailing Address - Phone:715-836-0064
Mailing Address - Fax:
Practice Address - Street 1:2620 STEIN BLVD STE B
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-2674
Practice Address - Country:US
Practice Address - Phone:715-836-0064
Practice Address - Fax:715-836-0065
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst