Provider Demographics
NPI:1609045822
Name:CONLEY, SCOTT KEVIN (LAC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:KEVIN
Last Name:CONLEY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 SEBASTOPOL AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-6337
Mailing Address - Country:US
Mailing Address - Phone:707-523-3517
Mailing Address - Fax:707-528-3560
Practice Address - Street 1:516 SEBASTOPOL AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-6337
Practice Address - Country:US
Practice Address - Phone:707-523-3517
Practice Address - Fax:707-528-3560
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL.AC. 4705171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist