Provider Demographics
NPI:1235403734
Name:STOUT, TONIA PAYNE (MA)
Entity Type:Individual
Prefix:MRS
First Name:TONIA
Middle Name:PAYNE
Last Name:STOUT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 SHUMAN BLVD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8458
Mailing Address - Country:US
Mailing Address - Phone:630-303-5380
Mailing Address - Fax:
Practice Address - Street 1:540 N MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-1467
Practice Address - Country:US
Practice Address - Phone:706-253-7244
Practice Address - Fax:706-253-7245
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003386231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist