Healthcare Provider Details

I. General information

NPI: 1790485712
Provider Name (Legal Business Name): KRISTEN STOUT M.S., ED.S., NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HUSKIES WAY
CADIZ OH
43907-1257
US

IV. Provider business mailing address

100 HUSKIES WAY
CADIZ OH
43907-1257
US

V. Phone/Fax

Practice location:
  • Phone: 740-942-7800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberOH3416153
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: