Provider Demographics
NPI:1548751266
Name:ARCHIBALD, SCOTT (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:ARCHIBALD
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10012 TULLER LOOP APT 306
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4053
Mailing Address - Country:US
Mailing Address - Phone:210-887-3353
Mailing Address - Fax:
Practice Address - Street 1:1200 5TH ST
Practice Address - Street 2:
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114-2009
Practice Address - Country:US
Practice Address - Phone:830-393-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2023-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist