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NPI Code Detail

MEDICARE: MYKAYLA SCOTT

MEDICARE: MYKAYLA SCOTT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker

General Provider Information

NPI Number : 1619636602
Entity Type Code : Individual
Provider Name (Legal Business Name) : MYKAYLA SCOTT
Provider Business Mailing Address
First Line : 1939 DIVISION AVE S
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49507-2480
Country : US
Telephone Number : 616-247-3815
Fax Number :
Provider Business Practice Location Address
First Line : 1939 DIVISION AVE S
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49507-2480
Country : US
Telephone Number : 616-247-3815
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2021
Last Update Date : 12/17/2021

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Directions to “ MYKAYLA SCOTT ” Practice Location

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