Healthcare Provider Details

I. General information

NPI: 1205761707
Provider Name (Legal Business Name): CIDAVIA SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1262 CEDAR ST
MONTICELLO MN
55362-8913
US

IV. Provider business mailing address

2304 GREENBRIAR LN
BUFFALO MN
55313-2367
US

V. Phone/Fax

Practice location:
  • Phone: 763-732-3351
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: