Healthcare Provider Details

I. General information

NPI: 1154375095
Provider Name (Legal Business Name): JENNIFER L SCOTT PSY D
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 PEPPER RIDGE RD
CINCINNATI OH
45244-1217
US

IV. Provider business mailing address

527 PEPPER RIDGE RD
CINCINNATI OH
45244-1217
US

V. Phone/Fax

Practice location:
  • Phone: 513-831-1388
  • Fax:
Mailing address:
  • Phone: 513-831-1388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6091
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: