Provider Demographics
NPI:1700651932
Name:STOUT, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
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 1:26129 175TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT RIPLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56449-2102
Mailing Address - Country:US
Mailing Address - Phone:320-630-9586
Mailing Address - Fax:
Practice Address - Street 1:26129 175TH AVE
Practice Address - Street 2:
Practice Address - City:FORT RIPLEY
Practice Address - State:MN
Practice Address - Zip Code:56449-2102
Practice Address - Country:US
Practice Address - Phone:320-630-9586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN28474104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker