Provider Demographics
NPI:1972093847
Name:JARREAU, SCOTT MICHAEL
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:MICHAEL
Last Name:JARREAU
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 1:7446 PRESIDENT DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-5419
Mailing Address - Country:US
Mailing Address - Phone:225-274-5467
Mailing Address - Fax:
Practice Address - Street 1:9150 BEREFORD DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2403
Practice Address - Country:US
Practice Address - Phone:225-960-7689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
XUP200089459OtherBLUECROSS BLUESHIELD