Provider Demographics
NPI:1992537021
Name:STOUT, CYNTHIA JANE (CDCA189476)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:JANE
Last Name:STOUT
Suffix:
Gender:F
Credentials:CDCA189476
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1826 ROXFORD ST
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-8107
Mailing Address - Country:US
Mailing Address - Phone:330-987-2344
Mailing Address - Fax:
Practice Address - Street 1:1826 ROXFORD ST
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-8107
Practice Address - Country:US
Practice Address - Phone:330-987-2344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No374J00000XNursing Service Related ProvidersDoula