Provider Demographics
NPI:1063696896
Name:SCOTT, JODIE DANIELLE (L AC)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:DANIELLE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 43RD AVE W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-1804
Mailing Address - Country:US
Mailing Address - Phone:206-579-1654
Mailing Address - Fax:206-400-1716
Practice Address - Street 1:700 WARREN AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4027
Practice Address - Country:US
Practice Address - Phone:206-579-1654
Practice Address - Fax:651-602-3601
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002918171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist