Healthcare Provider Details

I. General information

NPI: 1265357339
Provider Name (Legal Business Name): SCOTT KAZER MS, PPSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 DUDLEY BLVD
MCCLELLAN CA
95652-1024
US

IV. Provider business mailing address

5115 DUDLEY BLVD
MCCLELLAN CA
95652-1024
US

V. Phone/Fax

Practice location:
  • Phone: 916-566-1600
  • Fax:
Mailing address:
  • Phone: 916-566-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number240116001
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: