Provider Demographics
NPI:1639053119
Name:STOUT, ANDREW NICHOLAS (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:NICHOLAS
Last Name:STOUT
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4165 SCARLETT DR
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-8105
Mailing Address - Country:US
Mailing Address - Phone:423-736-5182
Mailing Address - Fax:
Practice Address - Street 1:210 E MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2341
Practice Address - Country:US
Practice Address - Phone:423-586-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8407235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist