MEDICARE: BJ SCOTT PSY.D.

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	103G00000X	Clinical Neuropsychologist	1972	OR
2	103TC0700X	Clinical Psychologist	1972	OR
3	103TP2701X	Group Psychotherapy Psychologist	1972	OR
4	103TR0400X	Rehabilitation Psychologist	1972	OR
5	103T00000X	Psychologist	1972	OR

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	:	1619103199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BJ SCOTT PSY.D.

Provider Business Mailing Address
First Line	:	2705 E. BURNSIDE ST
Second Line	:	SUITE 206
City	:	PORTLAND
State	:	OR
Zip	:	97214-1768
Country	:	US
Telephone Number	:	503-319-9553
Fax Number	:	360-844-5184

Provider Business Practice Location Address
First Line	:	2705 E. BURNSIDE ST
Second Line	:	SUITE 206
City	:	PORTLAND
State	:	OR
Zip	:	97214-1768
Country	:	US
Telephone Number	:	503-319-9553
Fax Number	:	360-844-5184

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

Provider Enumeration Date	:	06/10/2009
Last Update Date	:	10/05/2022

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Directions to “ BJ SCOTT PSY.D.” Practice Location

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