Provider Demographics
NPI:1093102154
Name:SCOTT, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:SCOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 VERDAE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3832
Mailing Address - Country:US
Mailing Address - Phone:864-288-3113
Mailing Address - Fax:864-288-3142
Practice Address - Street 1:101 VERDAE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3832
Practice Address - Country:US
Practice Address - Phone:864-288-3113
Practice Address - Fax:864-288-3142
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHTP-0910247200000X
SC0621237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other