Provider Demographics
NPI:1447584909
Name:SCOTT, MANDIE LEA
Entity Type:Individual
Prefix:
First Name:MANDIE
Middle Name:LEA
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8289 CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:LINGLE
Mailing Address - State:WY
Mailing Address - Zip Code:82223-8562
Mailing Address - Country:US
Mailing Address - Phone:307-837-0138
Mailing Address - Fax:
Practice Address - Street 1:8289 CEMETERY RD
Practice Address - Street 2:
Practice Address - City:LINGLE
Practice Address - State:WY
Practice Address - Zip Code:82223-8562
Practice Address - Country:US
Practice Address - Phone:307-837-0138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services