Provider Demographics
NPI:1770870370
Name:MCDONIEL, SCOTT O (PHD, FACN, FOS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:O
Last Name:MCDONIEL
Suffix:
Gender:M
Credentials:PHD, FACN, FOS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9362 TEDDY LN
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LONETREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-2870
Mailing Address - Country:US
Mailing Address - Phone:720-295-8595
Mailing Address - Fax:720-222-1987
Practice Address - Street 1:9362 TEDDY LN
Practice Address - Street 2:SUITE 206
Practice Address - City:LONETREE
Practice Address - State:CO
Practice Address - Zip Code:80124-2870
Practice Address - Country:US
Practice Address - Phone:720-295-8595
Practice Address - Fax:720-222-1987
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-03
Last Update Date:2011-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst