Provider Demographics
NPI:1679520092
Name:SAUTTER, SCOTT WILLARD (PHD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:WILLARD
Last Name:SAUTTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 HILLTOP WEST EXECUTIVE CENTER
Mailing Address - Street 2:216
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451
Mailing Address - Country:US
Mailing Address - Phone:757-498-9585
Mailing Address - Fax:757-468-1685
Practice Address - Street 1:1604 HILLTOP WEST CTR STE 216
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-6131
Practice Address - Country:US
Practice Address - Phone:757-498-9585
Practice Address - Fax:757-468-1685
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X
VA810001696103G00000X
VA0810001696103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA680000413Medicare ID - Type Unspecified
VAR65553Medicare UPIN