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General NPI Number Information
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NPI Number | 1518270875
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Entity Type | Individual
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Provider Name | SCOTT LETTOW CST, CFA
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Gender | Male
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Dates
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Enumeration Date | 07/15/2010
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Last Update Date | 07/15/2010
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Provider Practice Location Address
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Address Line | 9222 EWING AVE UNIT 302
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City | EVANSTON
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State | IL
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Zip | 60203-1717
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Country | US
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Telephone | 773-405-1727
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Fax |
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Provider Business Mailing Address
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Address Line | 9222 EWING #302
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City | EVANSTION
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State | IL
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Zip | 60203
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Country | US
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Telephone | 773-405-1727
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number | 238.000259
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License Number State | IL
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