Individual
THERESA LYNN STEWART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPT
Contact information
Practice address
1110 NEWPORT WAY, ROSEVILLE, CA 95661-5315
(916) 532-3628
Mailing address
1110 NEWPORT WAY, ROSEVILLE, CA 95661-5315
(916) 532-3628
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
41428
CA
Other
Enumeration date
06/01/2020
Last updated
06/01/2020
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