Provider Demographics
NPI:1518572080
Name:STOUT, JOY MARIE
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:MARIE
Last Name:STOUT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 S JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-2466
Mailing Address - Country:US
Mailing Address - Phone:440-787-1365
Mailing Address - Fax:
Practice Address - Street 1:2916 S JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-2466
Practice Address - Country:US
Practice Address - Phone:440-787-1365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide