Individual
DR. SCOTT DEATHERAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1580 OH-56, LONDON, OH 43140
(740) 852-2454
Mailing address
1100 WILFORD HALL LOOP BLDG 4554, JBSA LACKLAND, TX 78236-5638
(210) 292-4271
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
P.07981
OH
Other
Enumeration date
10/11/2016
Last updated
06/30/2021
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