Healthcare Provider Details

I. General information

NPI: 1679368237
Provider Name (Legal Business Name): SIMONE SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 DIVISION ST
RIVER FOREST IL
60305-1066
US

IV. Provider business mailing address

5916 W SUPERIOR ST
CHICAGO IL
60644-1046
US

V. Phone/Fax

Practice location:
  • Phone: 708-366-2490
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: