Provider Demographics
NPI:1760673222
Name:SCOTT, STEFFANY L (MS-CCC-SLP)
Entity Type:Individual
Prefix:
First Name:STEFFANY
Middle Name:L
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MS-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9230 N PEBBLE COVE LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-1758
Mailing Address - Country:US
Mailing Address - Phone:310-756-3858
Mailing Address - Fax:
Practice Address - Street 1:2656 E MAGIC VIEW DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6243
Practice Address - Country:US
Practice Address - Phone:208-996-2801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 8764235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist