Provider Demographics
NPI:1699870113
Name:DONALDSON, SCOTT L (PHD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:L
Last Name:DONALDSON
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 1:476 E RICH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-5316
Mailing Address - Country:US
Mailing Address - Phone:614-461-7244
Mailing Address - Fax:614-461-7245
Practice Address - Street 1:476 E RICH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5316
Practice Address - Country:US
Practice Address - Phone:614-461-7244
Practice Address - Fax:614-461-7245
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3791103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCP14081Medicare ID - Type Unspecified