Provider Demographics
NPI:1629615653
Name:SCOTT, DESIREE DOMINIQUE
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:DOMINIQUE
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 1:12074 NEWCASTLE AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-8998
Mailing Address - Country:US
Mailing Address - Phone:318-493-1474
Mailing Address - Fax:
Practice Address - Street 1:2133 SILVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4179
Practice Address - Country:US
Practice Address - Phone:225-939-1324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator