Provider Demographics
NPI:1154876266
Name:SCOTT, AMY MARIE (MSW, LISW)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARIE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 652
Mailing Address - Street 2:
Mailing Address - City:GREEN MOUNTAIN FALLS
Mailing Address - State:CO
Mailing Address - Zip Code:80819
Mailing Address - Country:US
Mailing Address - Phone:309-230-2707
Mailing Address - Fax:
Practice Address - Street 1:1414 N NEVADA AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7431
Practice Address - Country:US
Practice Address - Phone:563-355-1611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099249891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty