Individual
MR. STUART BRYAN STEWART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PEER SUPPORT SPECIAL
Contact information
Practice address
215 N G ST, LAKEVIEW, OR 97630-1417
(541) 947-6021
(541) 947-6020
Mailing address
429 S I ST, LAKEVIEW, OR 97630-1616
(541) 417-0987
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
241295
—
OR
Enumeration date
04/10/2018
Last updated
01/25/2019
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