Provider Demographics
NPI:1497905871
Name:FREEDMAN, SKOTT ELLIOT (MA, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:SKOTT
Middle Name:ELLIOT
Last Name:FREEDMAN
Suffix:
Gender:M
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 BLAINE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3408
Mailing Address - Country:US
Mailing Address - Phone:619-291-3515
Mailing Address - Fax:619-291-3529
Practice Address - Street 1:1524 BLAINE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3408
Practice Address - Country:US
Practice Address - Phone:619-291-3515
Practice Address - Fax:619-291-3529
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16563235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist