Provider Demographics
NPI:1396120713
Name:ANDERSON, SCOTT (CR)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:CR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7814 SE WASHINGTON ST
Mailing Address - Street 2:APT 3
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-2359
Mailing Address - Country:US
Mailing Address - Phone:503-841-9918
Mailing Address - Fax:
Practice Address - Street 1:10424 SE CHERRY BLOSSOM DR
Practice Address - Street 2:SUITE A2
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2801
Practice Address - Country:US
Practice Address - Phone:503-814-9918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist