Provider Demographics
NPI:1144521915
Name:SCOTT, DIANE WATSON (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:WATSON
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
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 10723
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27532-0723
Mailing Address - Country:US
Mailing Address - Phone:919-739-0047
Mailing Address - Fax:919-739-9041
Practice Address - Street 1:1214 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-3448
Practice Address - Country:US
Practice Address - Phone:919-739-0047
Practice Address - Fax:919-739-9041
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4274235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist