Provider Demographics
NPI:1518603083
Name:STOUT, MADELINE (LSW)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:STOUT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 N GILBERT ST STE 5
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-5639
Mailing Address - Country:US
Mailing Address - Phone:217-597-5869
Mailing Address - Fax:
Practice Address - Street 1:425 N GILBERT ST STE 5
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-5639
Practice Address - Country:US
Practice Address - Phone:217-504-0131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150107435104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker