Provider Demographics
NPI:1194867978
Name:GREWE, SCOTT D (PHD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:D
Last Name:GREWE
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 1:1950 KEENE ROAD
Mailing Address - Street 2:BUILDING O
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352
Mailing Address - Country:US
Mailing Address - Phone:509-627-2600
Mailing Address - Fax:509-627-2060
Practice Address - Street 1:1950 KEENE ROAD
Practice Address - Street 2:BUILDING O
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-627-2600
Practice Address - Fax:509-627-2060
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY000002343103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA48-1298528OtherTAX ID#