Provider Demographics
NPI:1508559071
Name:SCOTT, RODNEY (SUDCC AII059340121)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:
Last Name:SCOTT
Suffix:
Gender:M
Credentials:SUDCC AII059340121
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 E BASELINE RD APT 2027
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-7432
Mailing Address - Country:US
Mailing Address - Phone:602-667-3970
Mailing Address - Fax:
Practice Address - Street 1:14804 N CAVE CREEK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4945
Practice Address - Country:US
Practice Address - Phone:602-667-3970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAII059340121101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)