Provider Demographics
NPI:1457720203
Name:SCOTT, YOLANDA LOUISE
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:LOUISE
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 1:422 W FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48340-1620
Mailing Address - Country:US
Mailing Address - Phone:248-979-1864
Mailing Address - Fax:
Practice Address - Street 1:422 W FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-1620
Practice Address - Country:US
Practice Address - Phone:248-979-1864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker