MEDICARE: JILLIAN SCOTT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	235Z00000X	Speech-Language Pathologist	SZ9786	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457962367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLIAN SCOTT

Provider Business Mailing Address
First Line	:	2075 LINTON LAKE DR APT C
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-8262
Country	:	US
Telephone Number	:	518-645-5898
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 PROSPERITY FARMS RD STE D
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-5212
Country	:	US
Telephone Number	:	561-247-0289
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2020
Last Update Date	:	11/03/2020

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Directions to “ JILLIAN SCOTT ” Practice Location

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