Healthcare Provider Details

I. General information

NPI: 1639588130
Provider Name (Legal Business Name): SCOTT BUCKLEY NCSP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 HUY RD COLUMBUS HEARING IMPAIRED PROGRAM
COLUMBUS OH
43224-3531
US

IV. Provider business mailing address

566 E STANTON AVE
COLUMBUS OH
43214-1322
US

V. Phone/Fax

Practice location:
  • Phone: 614-365-5977
  • Fax:
Mailing address:
  • Phone: 614-203-7476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberOH1357249
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: