Healthcare Provider Details

I. General information

NPI: 1710779517
Provider Name (Legal Business Name): ASHLEY ELIZABETH STOUT LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 W CENTRAL AVE STE 101
EL DORADO KS
67042-2101
US

IV. Provider business mailing address

450 EUNICE ST
EL DORADO KS
67042-3338
US

V. Phone/Fax

Practice location:
  • Phone: 316-247-3063
  • Fax: 316-247-6833
Mailing address:
  • Phone: 316-452-4572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW12545
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: