Provider Demographics
NPI:1912044082
Name:SCOTT, CHARLES REX (MS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:REX
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MS
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 9397
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84109
Mailing Address - Country:US
Mailing Address - Phone:801-953-1184
Mailing Address - Fax:801-953-1194
Practice Address - Street 1:1050 E SOUTH TEMPLE
Practice Address - Street 2:SLRMC
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84102
Practice Address - Country:US
Practice Address - Phone:801-953-1184
Practice Address - Fax:801-953-1194
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1000046-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT20-1739412OtherTIN