Provider Demographics
NPI:1407501067
Name:SCOTT, JACQUELYNN RENEE (CADC-R)
Entity Type:Individual
Prefix:
First Name:JACQUELYNN
Middle Name:RENEE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CADC-R
Other - Prefix:
Other - First Name:JACQUELYNN
Other - Middle Name:RENEE
Other - Last Name:GRISHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:433 3RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-2860
Mailing Address - Country:US
Mailing Address - Phone:541-791-7193
Mailing Address - Fax:
Practice Address - Street 1:433 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2860
Practice Address - Country:US
Practice Address - Phone:541-791-7193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-12
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)