Healthcare Provider Details

I. General information

NPI: 1134014822
Provider Name (Legal Business Name): KATHRYN ELIZABETH SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 N 169TH DR
GOODYEAR AZ
85338-4551
US

IV. Provider business mailing address

33 N 169TH DR
GOODYEAR AZ
85338-4551
US

V. Phone/Fax

Practice location:
  • Phone: 907-231-4175
  • Fax:
Mailing address:
  • Phone: 907-231-4175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number12800124
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number12800124
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: