Provider Demographics
NPI:1285836270
Name:STOUT, RACHEL WALTERS (AUD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:WALTERS
Last Name:STOUT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:BETH
Other - Last Name:WALTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:4000 MITCHELLVILLE RD
Mailing Address - Street 2:B124
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3104
Mailing Address - Country:US
Mailing Address - Phone:301-464-2036
Mailing Address - Fax:301-464-9226
Practice Address - Street 1:4000 MITCHELLVILLE RD
Practice Address - Street 2:B124
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3104
Practice Address - Country:US
Practice Address - Phone:301-464-2036
Practice Address - Fax:301-464-9226
Is Sole Proprietor?:No
Enumeration Date:2007-06-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1998237600000X, 231H00000X
CAHA4066237700000X
MD01019231H00000X
DCAUD000088231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG00024Medicare PIN
MD780LMedicare PIN