Provider Demographics
NPI:1487042875
Name:SCOGGINS, KELLY MICHELLE (HIS)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MICHELLE
Last Name:SCOGGINS
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2934 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-2909
Mailing Address - Country:US
Mailing Address - Phone:619-283-8400
Mailing Address - Fax:619-283-8086
Practice Address - Street 1:2934 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-2909
Practice Address - Country:US
Practice Address - Phone:619-283-8400
Practice Address - Fax:619-283-8086
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAD7317237700000X, 235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist