Provider Demographics
NPI:1104844885
Name:STOUT, VALERIE L (CNM)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:L
Last Name:STOUT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7450 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:IL
Mailing Address - Zip Code:60501-1816
Mailing Address - Country:US
Mailing Address - Phone:708-458-0757
Mailing Address - Fax:708-458-3784
Practice Address - Street 1:7450 W 63RD ST
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:IL
Practice Address - Zip Code:60501-1816
Practice Address - Country:US
Practice Address - Phone:708-458-0757
Practice Address - Fax:708-458-3784
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.008254367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1104844885Medicaid
IL1104844885Medicaid
367830Medicare PIN