Provider Demographics
NPI:1467780411
Name:SCOGGIN, JAMIE GRISWOLD (LCSW)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:GRISWOLD
Last Name:SCOGGIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 RATCLIFF ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-4811
Mailing Address - Country:US
Mailing Address - Phone:318-455-1118
Mailing Address - Fax:318-390-4510
Practice Address - Street 1:920 PIERREMONT RD
Practice Address - Street 2:SUITE 205
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-2079
Practice Address - Country:US
Practice Address - Phone:318-868-5008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA88471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical