Individual
MARY CHARLES STEWART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CF-SLP
Contact information
Practice address
5825 GLENRIDGE DR STE 1-133, ATLANTA, GA 30328-7144
(678) 733-9318
(404) 902-5440
Mailing address
286 MIDVALE DR NE, ATLANTA, GA 30342-3327
(256) 566-4248
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
PCET003364
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PCET003364
PCE TEMPORARY SPEECH-LANGUAGE PATHOLOGY LICENSE
GA
Enumeration date
07/06/2021
Last updated
07/06/2021
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