Provider Demographics
NPI:1689851701
Name:SCOTT, DEIDRE M
Entity Type:Individual
Prefix:MRS
First Name:DEIDRE
Middle Name:M
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 1:90 NORTH 31ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601
Mailing Address - Country:US
Mailing Address - Phone:580-323-6021
Mailing Address - Fax:580-323-9375
Practice Address - Street 1:90 NORTH 31ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601
Practice Address - Country:US
Practice Address - Phone:580-323-6021
Practice Address - Fax:580-323-9375
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator