| Kenneth L Stewart, Phd, Ltd | |
|
11812 Wayzata Blvd Suite 120 Minnetonka MN 55305-2012 | |
| (612) 868-0366 | |
| Not Available |
| Full Name | Kenneth L Stewart, Phd, Ltd |
|---|---|
| Speciality | Psychologist |
| Location | 11812 Wayzata Blvd, Minnetonka, Minnesota |
| Authorized Official Name and Position | Kenneth Lyle Stewart (PRESIDENT) |
| Authorized Official Contact | 6128680366 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenneth L Stewart, Phd, Ltd 3108 Hennepin Ave S Minneapolis MN 55408-2619 Ph: (612) 868-0366 | Kenneth L Stewart, Phd, Ltd 11812 Wayzata Blvd Suite 120 Minnetonka MN 55305-2012 Ph: (612) 868-0366 |
| NPI Number | 1538466784 |
|---|---|
| Provider Enumeration Date | 02/24/2011 |
| Last Update Date | 02/24/2011 |
| Medicare PECOS PAC ID | 5597940247 |
|---|---|
| Medicare Enrollment ID | O20110425000283 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538466784 | NPI | - | NPPES |
| 945315600 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | LP2948 (Minnesota) | Primary |
| Provider Name | Kenneth L Stewart |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1528165446 PECOS PAC ID: 1658461181 Enrollment ID: I20110425000373 |
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