Individual
JESSICA MAE STOUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA, LBA
Contact information
Practice address
24 SW 89TH ST APT 101, OKLAHOMA CITY, OK 73139-8510
(206) 618-4726
(540) 898-1040
Mailing address
24 SW 89TH ST, OKLAHOMA CITY, OK 73139-8510
(206) 618-4726
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
0133001578
VA
103K00000X
Behavior Analyst
Primary
1-19-36386
OK
Other
Enumeration date
02/17/2020
Last updated
04/10/2023
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