Provider Demographics
NPI:1194087098
Name:STOUT, ELIZABETH MARY (SLP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MARY
Last Name:STOUT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 6TH ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-1795
Mailing Address - Country:US
Mailing Address - Phone:360-303-2486
Mailing Address - Fax:
Practice Address - Street 1:1015 6TH ST
Practice Address - Street 2:SUITE 106
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-1795
Practice Address - Country:US
Practice Address - Phone:360-303-2486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2017987Medicaid