Provider Demographics
NPI:1922587708
Name:SCANLON, NOAH S
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:S
Last Name:SCANLON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2483 S VINE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5254
Mailing Address - Country:US
Mailing Address - Phone:612-802-5992
Mailing Address - Fax:
Practice Address - Street 1:1777 S BELLAIRE ST STE 390
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4350
Practice Address - Country:US
Practice Address - Phone:720-515-4244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-12
Last Update Date:2018-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling