Provider Demographics
NPI:1134836331
Name:SCOUTON, JENNIFER JOY (LADC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOY
Last Name:SCOUTON
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 SW 10TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-2310
Mailing Address - Country:US
Mailing Address - Phone:218-616-0017
Mailing Address - Fax:
Practice Address - Street 1:1220 BIRCH ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-1500
Practice Address - Country:US
Practice Address - Phone:507-532-3008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305767101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)