MEDICARE: JACKIE L STOUT LCSW

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	1041C0700X	Clinical Social Worker	0904007252	VA

General Provider Information

NPI Number	:	1518280536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKIE L STOUT LCSW

Provider Business Mailing Address
First Line	:	410 MAPLE AVE W
Second Line	:	SUITE 7
City	:	VIENNA
State	:	VA
Zip	:	22180-4224
Country	:	US
Telephone Number	:	703-342-4671
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 MAPLE AVE W
Second Line	:	SUITE 7
City	:	VIENNA
State	:	VA
Zip	:	22180-4224
Country	:	US
Telephone Number	:	703-342-4671
Fax Number	:

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

Provider Enumeration Date	:	03/04/2010
Last Update Date	:	03/04/2010

Similar Medicare Providers

1013173004 — DR. GEORGE DAMON GANTSOUDES MD
Practice Location Address:

410 MAPLE AVE W STE 5
VIENNA, VA
22180-4224

Practice Phone: 646-240-9444
Practice Fax:

1275612319 — MAI HOANG NGUYEN MD
Practice Location Address:

410 MAPLE AVE W STE 3
VIENNA, VA
22180-4224

Practice Phone: 703-281-3626
Practice Fax: 703-281-3615

1528188471 — DR. KANAKA SRIRAM D.D.S.
Practice Location Address:

410 MAPLE AVE W STE 2
VIENNA, VA
22180-4224

Practice Phone: 703-255-2326
Practice Fax: 703-255-2325

1316276603 — VIRGINIA FAMILY COUNSELING, INC.
Practice Location Address:

410 MAPLE AVE W STE 7
VIENNA, VA
22180-4224

Practice Phone: 703-281-9313
Practice Fax: 703-281-9769

1720318231 — TRACY JOAN RYAN KIDD LCSW
Practice Location Address:

410 MAPLE AVE W STE 7
VIENNA, VA
22180-4224

Practice Phone: 703-281-9313
Practice Fax: 703-281-9769

1689076747 — VIENNA DERMATOLOGY, LLC
Practice Location Address:

410 MAPLE AVE W STE 3
VIENNA, VA
22180-4224

Practice Phone: 703-281-3626
Practice Fax: 703-281-3615

Directions to “ JACKIE L STOUT LCSW” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.