Healthcare Provider Details

I. General information

NPI: 1346975067
Provider Name (Legal Business Name): JOHNNA STOUP AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2616 SHERWOOD HALL LN STE 408
ALEXANDRIA VA
22306-3154
US

IV. Provider business mailing address

6355 WALKER LN STE 411
ALEXANDRIA VA
22310-3250
US

V. Phone/Fax

Practice location:
  • Phone: 703-780-8929
  • Fax: 703-921-1056
Mailing address:
  • Phone: 703-922-4262
  • Fax: 703-921-1056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2201001884
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: