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General NPI Number Information
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NPI Number | 1134519317
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Entity Type | Individual
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Provider Name | JEREMIAH SCOTT
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Gender | Male
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Dates
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Enumeration Date | 01/27/2015
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Last Update Date | 07/31/2023
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Provider Practice Location Address
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Address Line | 475 LEWIS ST
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City | PAGOSA SPRINGS
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State | CO
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Zip | 81147
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Country | US
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Telephone | 970-335-2298
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Fax | 970-264-2108
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Provider Business Mailing Address
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Address Line | 708 FOXFARM CIR
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City | BAYFIELD
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State | CO
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Zip | 81122-8847
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Country | US
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Telephone | 970-335-2298
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Fax | 970-264-2108
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LSW.0009920679
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW.09924456
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License Number State | CO
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