Provider Demographics
NPI:1225591126
Name:SCANTLIN, ANDREA AMY
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:AMY
Last Name:SCANTLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11484 B AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-2603
Mailing Address - Country:US
Mailing Address - Phone:530-889-7170
Mailing Address - Fax:530-889-7125
Practice Address - Street 1:11484 B AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2603
Practice Address - Country:US
Practice Address - Phone:530-889-7170
Practice Address - Fax:530-889-7125
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor