Healthcare Provider Details

I. General information

NPI: 1922411800
Provider Name (Legal Business Name): JENNIFER SCOTT M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15399 AUTUMN LN
DUMFRIES VA
22025-1007
US

IV. Provider business mailing address

15399 AUTUMN LN
DUMFRIES VA
22025-1007
US

V. Phone/Fax

Practice location:
  • Phone: 703-686-8101
  • Fax:
Mailing address:
  • Phone: 808-256-0252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number10896
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202010581
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number79330
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: