Healthcare Provider Details

I. General information

NPI: 1710643630
Provider Name (Legal Business Name): MADELEINE SCANLON MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2021
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 EXECUTIVE PARK DR STE 320
CINCINNATI OH
45241-4015
US

IV. Provider business mailing address

4015 EXECUTIVE PARK DR STE 320
CINCINNATI OH
45241-4015
US

V. Phone/Fax

Practice location:
  • Phone: 513-563-0488
  • Fax: 513-563-0428
Mailing address:
  • Phone: 513-563-0488
  • Fax: 513-563-0428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2506565
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: