Provider Demographics
NPI:1104324888
Name:STOUT, ANDREW CHRISTOPHER (MED CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:CHRISTOPHER
Last Name:STOUT
Suffix:
Gender:M
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 EXCHANGE PL APT 314
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-1886
Mailing Address - Country:US
Mailing Address - Phone:910-850-8762
Mailing Address - Fax:
Practice Address - Street 1:1101 EXCHANGE PL APT 314
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-1886
Practice Address - Country:US
Practice Address - Phone:910-850-8762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12363235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist