Basic Information
| Provider Information | |||||||||
| NPI: | 1114012614 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ESCANDELL | ||||||||
| FirstName: | VINCENT | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | BAYNE-JONES ARMY COMMUNITY HOSPITAL | ||||||||
| Address2: | 1585 THIRD ST | ||||||||
| City: | FORT POLK | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184511115 | ||||||||
| FaxNumber: | 3184489088 | ||||||||
| Practice Location | |||||||||
| Address1: | 1585 3RD ST | ||||||||
| Address2: | |||||||||
| City: | FORT POLK | ||||||||
| State: | LA | ||||||||
| PostalCode: | 714595102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184730010 | ||||||||
| FaxNumber: | 3184835096 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 11/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 784 | LA | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103G00000X | 784 | LA | Y | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.