Provider Demographics
NPI:1154566982
Name:STOUT, CARINDA (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CARINDA
Middle Name:
Last Name:STOUT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MISS
Other - First Name:CARINDA
Other - Middle Name:
Other - Last Name:FOERST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:963 TOWN CENTER DR
Mailing Address - Street 2:STE 100
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8254
Mailing Address - Country:US
Mailing Address - Phone:386-774-9880
Mailing Address - Fax:386-774-2898
Practice Address - Street 1:963 TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8254
Practice Address - Country:US
Practice Address - Phone:386-774-9880
Practice Address - Fax:386-774-2898
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9464235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFE430ZOtherMEDICARE PTAN