Healthcare Provider Details

I. General information

NPI: 1114733706
Provider Name (Legal Business Name): LANA JO SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/09/2024
Certification Date: 12/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 W MAIN ST
RIPON CA
95366-2406
US

IV. Provider business mailing address

4000 FARA BIUNDO DR APT 8
MODESTO CA
95355-9562
US

V. Phone/Fax

Practice location:
  • Phone: 209-599-4225
  • Fax:
Mailing address:
  • Phone: 209-484-0513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: