Provider Demographics
NPI:1023378957
Name:STOUT, JENNIFER L (LPC)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:L
Last Name:STOUT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NORTH CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446
Mailing Address - Country:US
Mailing Address - Phone:215-362-7955
Mailing Address - Fax:215-362-5662
Practice Address - Street 1:200 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-2657
Practice Address - Country:US
Practice Address - Phone:215-362-7955
Practice Address - Fax:215-362-5662
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006266101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional