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Individual

DR. SCOTT A. WYLIE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PH.D.

Contact information

Practice address
220 ABRAHAM FLEXNER WAY, LOUISVILLE, KY 40202
(502) 899-3626
(502) 899-7970
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-0325
(502) 588-0326

Taxonomy

Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
0810003670
VA
103TC0700X
Clinical Psychologist
0810003670
VA
103TC0700X
Clinical Psychologist
Primary
173223
KY
103TC0700X
Clinical Psychologist
PHD3062
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0810003670
VA STATE LICENSE
VA
Enumeration date
07/28/2006
Last updated
12/07/2018
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