MEDICARE: MR. SCOTT STANGE LCSW

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	1041C0700X	Clinical Social Worker	149006942	IL
2	104100000X	Social Worker	149-006942	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	149006942	OTHER	IL	BLUE CROSS ILLINOIS NUMBE
2	99254	OTHER	IL	BLUE CROSS IOWA
3	JB420B1	OTHER	IL	JOHN DEERE PROVIDER NUMB

General Provider Information

NPI Number	:	1356334106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT STANGE LCSW

Provider Business Mailing Address
First Line	:	533 30TH ST
Second Line	:
City	:	ROCK ISLAND
State	:	IL
Zip	:	61201-1942
Country	:	US
Telephone Number	:	309-235-7644
Fax Number	:

Provider Business Practice Location Address
First Line	:	ROCK ISLAND ARSENAL HEALTH CLINIC, (RIAHC)
Second Line	:	ATTN: MCXM-DMC, BUILDING 110
City	:	ROCK ISLAND ARSENAL
State	:	IL
Zip	:	61299-7240
Country	:	US
Telephone Number	:	309-782-0805
Fax Number	:	309-782-0810

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	09/08/2023

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Directions to “ MR. SCOTT STANGE LCSW” Practice Location

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