Provider Demographics
NPI:1679891931
Name:SCOTT, KATRINA A (MEDCCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:A
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MEDCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1634 BLACK JACK SIMPSON RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-8388
Mailing Address - Country:US
Mailing Address - Phone:252-578-3468
Mailing Address - Fax:252-364-2454
Practice Address - Street 1:1634 BLACK JACK SIMPSON RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-8388
Practice Address - Country:US
Practice Address - Phone:252-578-3468
Practice Address - Fax:252-364-2454
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7090235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist