Provider Demographics
NPI:1710270699
Name:PERLOW, SCOTT D (MA, CCC-SLP/L)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:D
Last Name:PERLOW
Suffix:
Gender:M
Credentials:MA, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6244
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80424-6244
Mailing Address - Country:US
Mailing Address - Phone:970-485-3662
Mailing Address - Fax:
Practice Address - Street 1:51 BROOK STREET
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:CO
Practice Address - Zip Code:80424
Practice Address - Country:US
Practice Address - Phone:970-485-3662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO195752235Z00000X
COSLP.0002388235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist