Provider Demographics
NPI:1700535812
Name:AHRENDT, SCOTT A
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:AHRENDT
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 1:738 SHETLAND DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-6644
Mailing Address - Country:US
Mailing Address - Phone:401-595-2372
Mailing Address - Fax:
Practice Address - Street 1:738 SHETLAND DR
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-6644
Practice Address - Country:US
Practice Address - Phone:401-595-2372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB696433106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician