Provider Demographics
NPI:1588154439
Name:SCOTT, DIANNA BEEVERS
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:BEEVERS
Last Name:SCOTT
Suffix:
Gender:F
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 296
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05255-0296
Mailing Address - Country:US
Mailing Address - Phone:802-379-8992
Mailing Address - Fax:
Practice Address - Street 1:91 VT ROUTE 11
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:VT
Practice Address - Zip Code:05148-9539
Practice Address - Country:US
Practice Address - Phone:802-824-6811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT144.0118286235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist