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Individual
TARA J STOUT
Active
Individual
TARA J STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
SW138639
PA
1041C0700X
Clinical Social Worker
Primary
CW025700
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15716928
CAQH
—
Enumeration date
09/13/2022
Last updated
03/27/2025
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