Provider Demographics
NPI:1295769339
Name:SCHOTT, JACQUELINE RUTH (PHD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:RUTH
Last Name:SCHOTT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:RUTH
Other - Last Name:SCHOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:604 S SALTAIR AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-4135
Mailing Address - Country:US
Mailing Address - Phone:310-472-5283
Mailing Address - Fax:
Practice Address - Street 1:604 S SALTAIR AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-4135
Practice Address - Country:US
Practice Address - Phone:310-472-5283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11025103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist