Healthcare Provider Details

I. General information

NPI: 1588154439
Provider Name (Legal Business Name): DIANNA BEEVERS SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 VT ROUTE 11
LONDONDERRY VT
05148-9539
US

IV. Provider business mailing address

PO BOX 296
MANCHESTER CENTER VT
05255-0296
US

V. Phone/Fax

Practice location:
  • Phone: 802-824-6811
  • Fax:
Mailing address:
  • Phone: 802-379-8992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number144.0118286
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: