MEDICARE: KAYLA ROGERS STOUT MED CCC-SLP

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
1	235Z00000X	Speech-Language Pathologist	SLP008610	GA

General Provider Information

NPI Number	:	1699171595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA ROGERS STOUT MED CCC-SLP

Provider Business Mailing Address
First Line	:	8459 LEXIE LN
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-5796
Country	:	US
Telephone Number	:	229-318-9594
Fax Number	:

Provider Business Practice Location Address
First Line	:	37 BROCK DR
Second Line	:
City	:	LOOKOUT MOUNTAIN
State	:	GA
Zip	:	30750-2207
Country	:	US
Telephone Number	:	229-318-9594
Fax Number	:	423-702-4493

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2014
Last Update Date	:	11/08/2018

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Directions to “ KAYLA ROGERS STOUT MED CCC-SLP” Practice Location

Language	Start Address	Practice Location

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