Provider Demographics
NPI:1891420105
Name:STOUT, CORIANN (RDH)
Entity Type:Individual
Prefix:
First Name:CORIANN
Middle Name:
Last Name:STOUT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 ANNA GOODMAN RD
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-5121
Mailing Address - Country:US
Mailing Address - Phone:724-396-5296
Mailing Address - Fax:
Practice Address - Street 1:195 ANNA GOODMAN RD
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-5121
Practice Address - Country:US
Practice Address - Phone:724-396-5296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty