Individual
DR. SCOTT A. WYLIE
Active
Individual
DR. SCOTT A. WYLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
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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