Healthcare Provider Details

I. General information

NPI: 1750167656
Provider Name (Legal Business Name): ELLEN SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17306 MADISON AVE
LAKEWOOD OH
44107-3533
US

IV. Provider business mailing address

20201 LORAIN RD APT 510
FAIRVIEW PARK OH
44126-3403
US

V. Phone/Fax

Practice location:
  • Phone: 216-543-5232
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2305165-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: