Healthcare Provider Details

I. General information

NPI: 1154566982
Provider Name (Legal Business Name): CARINDA STOUT MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARINDA FOERST MA, CCC-SLP

II. Dates (important events)

Enumeration Date: 12/08/2008
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

963 TOWN CENTER DR
ORANGE CITY FL
32763-8254
US

IV. Provider business mailing address

963 TOWN CENTER DR STE 100
ORANGE CITY FL
32763-8254
US

V. Phone/Fax

Practice location:
  • Phone: 386-774-9880
  • Fax: 386-774-2898
Mailing address:
  • Phone: 386-774-9880
  • Fax: 386-774-2898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA9464
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: