Provider Demographics
NPI:1134433899
Name:CALDERWOOD, SCOTT W
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:W
Last Name:CALDERWOOD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W BROADWAY STE 800
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-3546
Mailing Address - Country:US
Mailing Address - Phone:619-356-1315
Mailing Address - Fax:
Practice Address - Street 1:3660 CLAIREMONT DR STE 2
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5909
Practice Address - Country:US
Practice Address - Phone:619-356-1315
Practice Address - Fax:619-860-1270
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPE6269235Z00000X
CASP18894235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist