Individual
NICHOLE STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSCCCSLP
Contact information
Practice address
1504 N CEDAR AVE, TAHLEQUAH, OK 74464-6700
(918) 456-3456
Mailing address
701 N WILLEY ST, FORT GIBSON, OK 74434-8235
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
OK
Other
Enumeration date
10/27/2019
Last updated
10/27/2019
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