Healthcare Provider Details

I. General information

NPI: 1760673222
Provider Name (Legal Business Name): STEFFANY L SCOTT M.S.-C.C.C.-S.L.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 02/28/2022
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2656 E MAGIC VIEW DR
MERIDIAN ID
83642-6243
US

IV. Provider business mailing address

9230 N PEBBLE COVE LN
BOISE ID
83714-1758
US

V. Phone/Fax

Practice location:
  • Phone: 208-996-2801
  • Fax:
Mailing address:
  • Phone: 310-756-3858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 8764
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: