Provider Demographics
NPI:1386859965
Name:SCOTT, CARLY ANN (MS)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:ANN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 W VUELTA FRISO
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629-8671
Mailing Address - Country:US
Mailing Address - Phone:520-465-2659
Mailing Address - Fax:520-886-6878
Practice Address - Street 1:309 W VUELTA FRISO
Practice Address - Street 2:
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629-8671
Practice Address - Country:US
Practice Address - Phone:520-465-2659
Practice Address - Fax:520-886-6878
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP4622235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ164513OtherAHCCCS PROVIDER NUMBER