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NPI Code Detail

MEDICARE: TERRY WAYNARD SCOTT LLMSW

MEDICARE: TERRY WAYNARD SCOTT LLMSW
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
11041C0700XClinical Social Worker6851105875MI

General Provider Information

NPI Number : 1902321177
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRY WAYNARD SCOTT LLMSW
Provider Business Mailing Address
First Line : 26184 OUTER DR
Second Line :
City : LINCOLN PARK
State : MI
Zip : 48146-2084
Country : US
Telephone Number : 313-389-7500
Fax Number : 313-389-7510
Provider Business Practice Location Address
First Line : 5958 N CANTON CENTER RD STE 900
Second Line :
City : CANTON
State : MI
Zip : 48187-2740
Country : US
Telephone Number : 517-882-3732
Fax Number : 517-882-3633
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2017
Last Update Date : 05/21/2024

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