Individual
MRS. MELISSA A STEWART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
106 DACUS DR, SIKESTON, MO 63801-9013
(573) 471-4219
Mailing address
106 DACUS DR, SIKESTON, MO 63801-9013
(573) 471-4219
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
EC2-0290-1011
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1629195607
NPI
MO
Enumeration date
04/12/2012
Last updated
09/15/2015
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