Individual
BROOKE E STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
542 E BOUGHTON RD, BOLINGBROOK, IL 60440-2181
(630) 783-1850
Mailing address
542 E BOUGHTON RD, BOLINGBROOK, IL 60440-2181
(630) 783-1850
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09932455
BLUE CROSS BLUE SHIELD
IL
Enumeration date
05/26/2007
Last updated
02/25/2008
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