Healthcare Provider Details

I. General information

NPI: 1689678294
Provider Name (Legal Business Name): DEBORAH KAY SCOTT LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3249 BARNEY AVE
PEKIN IL
61554-6234
US

IV. Provider business mailing address

6422 N UPLAND TER
PEORIA IL
61615-2540
US

V. Phone/Fax

Practice location:
  • Phone: 309-347-5522
  • Fax: 309-347-7302
Mailing address:
  • Phone: 309-693-0307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: