Individual
KRYSTA STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
33 ERSKINE LN, SCOTT DEPOT, WV 25560-7842
(681) 235-7001
Mailing address
100 HIDDEN PARK DR APT 12, HUNTINGTON, WV 25705-2178
(210) 840-3352
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-21-195632
WV
Other
Enumeration date
04/13/2022
Last updated
04/13/2022
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