Healthcare Provider Details

I. General information

NPI: 1134519317
Provider Name (Legal Business Name): JEREMIAH SCOTT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MERCURY VILLAGE DR
DURANGO CO
81301-8955
US

IV. Provider business mailing address

PO BOX 1328
DURANGO CO
81302-1328
US

V. Phone/Fax

Practice location:
  • Phone: 970-335-2342
  • Fax: 970-335-2438
Mailing address:
  • Phone: 970-335-2342
  • Fax: 970-335-2438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW.0009920679
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09924456
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: