Healthcare Provider Details

I. General information

NPI: 1619424652
Provider Name (Legal Business Name): JESSICA SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43520 DIVISION ST
LANCASTER CA
93535-4089
US

IV. Provider business mailing address

39103 163RD ST E
PALMDALE CA
93591-3421
US

V. Phone/Fax

Practice location:
  • Phone: 661-266-4783
  • Fax:
Mailing address:
  • Phone: 626-272-3527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number121893
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: