Provider Demographics
NPI:1659589331
Name:DISBROW, SCOTT DAVID (MED, CCC-A)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:DAVID
Last Name:DISBROW
Suffix:
Gender:M
Credentials:MED, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 MONUMENT AVE
Mailing Address - Street 2:SUITE S
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1452
Mailing Address - Country:US
Mailing Address - Phone:804-288-3752
Mailing Address - Fax:
Practice Address - Street 1:5500 MONUMENT AVE
Practice Address - Street 2:SUITE S
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1452
Practice Address - Country:US
Practice Address - Phone:804-288-3752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001344231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist