Individual
DR. REBECCA STOUT-FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
912 S WOOD ST, CHICAGO, CHICAGO, IL 60612-4300
(312) 413-2037
Mailing address
912 S WOOD ST, CHICAGO, CHICAGO, IL 60612-4300
(312) 413-2037
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071007763
IL
Other
Enumeration date
10/05/2010
Last updated
10/05/2010
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