MEDICARE: MRS. JILL CAROL SCOTT CADC 1

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor		OR

General Provider Information

NPI Number	:	1710280367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JILL CAROL SCOTT CADC 1

Provider Business Mailing Address
First Line	:	621 W MADRONE ST
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97470-3090
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	615 5TH ST
Second Line	:
City	:	BROOKINGS
State	:	OR
Zip	:	97415-9199
Country	:	US
Telephone Number	:	541-813-2535
Fax Number	:	541-813-2536

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2010
Last Update Date	:	12/16/2021

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