Provider Demographics
NPI:1821310376
Name:SCOTT, ANISSA MARIE (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANISSA
Middle Name:MARIE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:ANISSA
Other - Middle Name:MARIE
Other - Last Name:SPEARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, CCC-SLP
Mailing Address - Street 1:16079 AIKENS RD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-4901
Mailing Address - Country:US
Mailing Address - Phone:225-673-6316
Mailing Address - Fax:
Practice Address - Street 1:16079 AIKENS RD
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-4901
Practice Address - Country:US
Practice Address - Phone:225-673-6316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006281235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist