MEDICARE: KATHERINE SCOTT LCPC, BC-DMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	180.015077	IL

General Provider Information

NPI Number	:	1336982974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE SCOTT LCPC, BC-DMT

Provider Business Mailing Address
First Line	:	1543 N ROCKWELL ST APT 1F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2359
Country	:	US
Telephone Number	:	908-601-2866
Fax Number	:

Provider Business Practice Location Address
First Line	:	1543 N ROCKWELL ST APT 1F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2359
Country	:	US
Telephone Number	:	908-601-2866
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2024
Last Update Date	:	08/02/2024

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