Healthcare Provider Details

I. General information

NPI: 1982201851
Provider Name (Legal Business Name): NICOLE MICHELLE SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N PERRY ST
DAVENPORT IA
52801-1617
US

IV. Provider business mailing address

310 W 61ST PL
DAVENPORT IA
52806-2129
US

V. Phone/Fax

Practice location:
  • Phone: 563-328-5800
  • Fax:
Mailing address:
  • Phone: 563-650-3561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101188
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: