Provider Demographics
NPI:1669620548
Name:SCOTT, CATHERINE MARIE (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:MARIE
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 1:17491 E JACKRABBIT RD
Mailing Address - Street 2:
Mailing Address - City:MAYER
Mailing Address - State:AZ
Mailing Address - Zip Code:86333-4329
Mailing Address - Country:US
Mailing Address - Phone:928-899-1438
Mailing Address - Fax:928-583-7113
Practice Address - Street 1:17491 E JACKRABBIT RD
Practice Address - Street 2:
Practice Address - City:MAYER
Practice Address - State:AZ
Practice Address - Zip Code:86333-4329
Practice Address - Country:US
Practice Address - Phone:928-899-1438
Practice Address - Fax:928-583-7113
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP4184235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ872285Medicaid