Provider Demographics
NPI:1053680793
Name:STOUT, SARAH (ND)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:
Last Name:STOUT
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 FAIRLEIGH WAY
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-2241
Mailing Address - Country:US
Mailing Address - Phone:317-408-0110
Mailing Address - Fax:
Practice Address - Street 1:12 FAIRLEIGH WAY
Practice Address - Street 2:
Practice Address - City:BALLSTON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12019-2241
Practice Address - Country:US
Practice Address - Phone:317-408-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education