Individual
BLAIR STEWART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1704 W INDUSTRIAL DR, ROGERS, AR 72756-2492
(479) 439-6906
Mailing address
1319 S HOLLYWOOD AVE, FAYETTEVILLE, AR 72701-6055
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
XCHK0038634803
BLUE CROSS BLUE SHIELD
—
Enumeration date
01/14/2020
Last updated
01/14/2020
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