Provider Demographics
NPI:1871179010
Name:STEWART, JUSTIN RYAN (SUDP-T)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:RYAN
Last Name:STEWART
Suffix:
Gender:M
Credentials:SUDP-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10344 14TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98168-1689
Mailing Address - Country:US
Mailing Address - Phone:206-767-0244
Mailing Address - Fax:206-767-5964
Practice Address - Street 1:10344 14TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98168-1689
Practice Address - Country:US
Practice Address - Phone:206-767-0244
Practice Address - Fax:206-767-5964
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP61356330101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)