Provider Demographics
NPI:1881777209
Name:POLAND, SCOTT A (PHD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:POLAND
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 272432
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80527-2432
Mailing Address - Country:US
Mailing Address - Phone:970-282-7151
Mailing Address - Fax:970-493-8009
Practice Address - Street 1:1302 S SHIELDS ST UNIT A2-3
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-4803
Practice Address - Country:US
Practice Address - Phone:970-282-7151
Practice Address - Fax:970-493-8009
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2245103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical