Provider Demographics
NPI:1023378957
Name:STOUT-MIDDLECAMP, JENNIFER L (LPC)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:L
Last Name:STOUT-MIDDLECAMP
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 S BETHLEHEM PIKE
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-5821
Mailing Address - Country:US
Mailing Address - Phone:267-405-2321
Mailing Address - Fax:
Practice Address - Street 1:156 S BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-5821
Practice Address - Country:US
Practice Address - Phone:267-405-2321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006266101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional