Provider Demographics
NPI:1619277001
Name:SCOTT, STEPHANIE J
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:J
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 NE 19TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73121-2879
Mailing Address - Country:US
Mailing Address - Phone:405-875-7311
Mailing Address - Fax:
Practice Address - Street 1:3309 NE 19TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73121-2879
Practice Address - Country:US
Practice Address - Phone:405-875-7311
Practice Address - Fax:405-605-1957
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200120060AMedicaid