Provider Demographics
NPI:1013035005
Name:DECOUTO, SCOTT MARSHALL (LAC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:MARSHALL
Last Name:DECOUTO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:MARSHALL
Other - Middle Name:
Other - Last Name:DECOUTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:11410 NE 124TH ST
Mailing Address - Street 2:#350
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-4305
Mailing Address - Country:US
Mailing Address - Phone:206-992-1231
Mailing Address - Fax:
Practice Address - Street 1:143 PARK LN
Practice Address - Street 2:SUITE 204
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6172
Practice Address - Country:US
Practice Address - Phone:206-992-1231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002815171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist