Provider Demographics
NPI:1649878562
Name:SCOTT, JAY THOMAS (CDP)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:THOMAS
Last Name:SCOTT
Suffix:
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2304
Mailing Address - Country:US
Mailing Address - Phone:206-464-1570
Mailing Address - Fax:
Practice Address - Street 1:222 WALL ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-1431
Practice Address - Country:US
Practice Address - Phone:206-441-3329
Practice Address - Fax:206-441-3014
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist