Healthcare Provider Details

I. General information

NPI: 1649604273
Provider Name (Legal Business Name): ROXANNE SCOTT M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2013
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 NE KELLY AVE STE. 200
GRESHAM OR
97030-5629
US

IV. Provider business mailing address

912 NE KELLY AVE STE. 200
GRESHAM OR
97030-5629
US

V. Phone/Fax

Practice location:
  • Phone: 503-258-4600
  • Fax:
Mailing address:
  • Phone: 503-258-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: