Individual provider Active NPI

Ann Louise Stout, MSW, LCSW

  • Clinical Social Worker
  • Glen Ellyn, IL
National Provider Identifier
1790830917
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
800 Roosevelt Rd Ste B104
Glen Ellyn, IL 60137-5858
Phone
(630) 858-5105
Fax
(630) 858-8299
NPI assigned
Jan 25, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X IL Primary

Addresses

Primary practice location

800 Roosevelt Rd Ste B104
Glen Ellyn, IL 60137-5858

Mailing address

800 Roosevelt Rd Ste B104
Glen Ellyn, IL 60137-5858
Phone (630) 858-5105

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
149-002570ILMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1790830917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 ROOSEVELT RD STE B104",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601375858",
            "telephone_number": "630-858-5105",
            "fax_number": "630-858-8299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 ROOSEVELT RD STE B104",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601375858",
            "telephone_number": "630-858-5105",
            "fax_number": "630-858-8299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOUT",
        "first_name": "ANN",
        "middle_name": "LOUISE",
        "name_prefix": "Ms.",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Ellyn, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.