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NPI Code Detail

MEDICARE: EMILY DANIELLE STOUT

MEDICARE: EMILY DANIELLE STOUT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1175T00000XPeer Specialist24-CRM-2976OR
2101YA0400XAddiction (Substance Use Disorder) CounselorT-25-5581OR

General Provider Information

NPI Number : 1164245122
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY DANIELLE STOUT
Provider Business Mailing Address
First Line : PO BOX 17818
Second Line :
City : SALEM
State : OR
Zip : 97305-7818
Country : US
Telephone Number : 503-363-2021
Fax Number :
Provider Business Practice Location Address
First Line : 3321 HAROLD DR NE
Second Line :
City : SALEM
State : OR
Zip : 97305-1339
Country : US
Telephone Number : 503-363-2021
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2024
Last Update Date : 01/29/2026

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Directions to “ EMILY DANIELLE STOUT ” Practice Location

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