Healthcare Provider Details

I. General information

NPI: 1154244507
Provider Name (Legal Business Name): ROBIN SCOTT LPC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 S WEBSTER AVE
GREEN BAY WI
54301-3959
US

IV. Provider business mailing address

430 S WEBSTER AVE
GREEN BAY WI
54301-3959
US

V. Phone/Fax

Practice location:
  • Phone: 920-837-3530
  • Fax:
Mailing address:
  • Phone: 920-837-3530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number20376-130
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7307-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: