Provider Demographics
NPI:1073985701
Name:HIRSCH, SCOTT CHARLES (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:CHARLES
Last Name:HIRSCH
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2804
Mailing Address - Country:US
Mailing Address - Phone:719-423-3044
Mailing Address - Fax:
Practice Address - Street 1:315 W 11TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2804
Practice Address - Country:US
Practice Address - Phone:719-423-3044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-21
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4325235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKN082717622Medicaid