Healthcare Provider Details

I. General information

NPI: 1114012614
Provider Name (Legal Business Name): VINCENT ANTHONY ESCANDELL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 3RD ST
FORT POLK LA
71459-5102
US

IV. Provider business mailing address

BAYNE-JONES ARMY COMMUNITY HOSPITAL 1585 THIRD ST
FORT POLK LA
71459
US

V. Phone/Fax

Practice location:
  • Phone: 318-473-0010
  • Fax: 318-483-5096
Mailing address:
  • Phone: 318-451-1115
  • Fax: 318-448-9088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number784
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number784
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: