Provider Demographics
NPI:1851963847
Name:SCOTT, JANESSA
Entity Type:Individual
Prefix:
First Name:JANESSA
Middle Name:
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:PO BOX 7222
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92375-0222
Mailing Address - Country:US
Mailing Address - Phone:909-810-7607
Mailing Address - Fax:
Practice Address - Street 1:7003 MARCONI ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CALIFORNIA
Practice Address - Zip Code:90255
Practice Address - Country:US
Practice Address - Phone:909-810-7607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-11
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY5468484103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst