=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063524494
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WENDY STONE SCOTT PCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1005 ABBE RD N
-----------------------------------------------------
City | ELYRIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44035-1613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 180-099-5522
-----------------------------------------------------
Fax | 440-365-6519
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1437 LARCHMONT AVE
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44107-3401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-227-9647
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | E-0007643
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------