MEDICARE: SCOTT D WEBSTER LLP

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	103T00000X	Psychologist	6301009298	MI

General Provider Information

NPI Number	:	1821396979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT D WEBSTER LLP

Provider Business Mailing Address
First Line	:	1920 GUTHRIE AVE
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-3586
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1920 GUTHRIE AVE
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-3586
Country	:	US
Telephone Number	:	248-546-9542
Fax Number	:

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

Provider Enumeration Date	:	03/13/2011
Last Update Date	:	03/13/2011

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Directions to “ SCOTT D WEBSTER LLP” Practice Location

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