Provider Demographics
NPI:1215795695
Name:SCOTT, DYLAN J
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:J
Last Name:SCOTT
Suffix:
Gender:M
Credentials:
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 579
Mailing Address - Street 2:
Mailing Address - City:LUTCHER
Mailing Address - State:LA
Mailing Address - Zip Code:70071-0579
Mailing Address - Country:US
Mailing Address - Phone:225-715-1001
Mailing Address - Fax:
Practice Address - Street 1:2763 LAKE PERIQUE DR
Practice Address - Street 2:
Practice Address - City:PAULINA
Practice Address - State:LA
Practice Address - Zip Code:70763-2501
Practice Address - Country:US
Practice Address - Phone:225-331-0580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator