Provider Demographics
NPI:1215261730
Name:SCOTT, JOANN (DT)
Entity type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12248 FAIRWAY CIR
Mailing Address - Street 2:7-C
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-3622
Mailing Address - Country:US
Mailing Address - Phone:708-489-2482
Mailing Address - Fax:
Practice Address - Street 1:12248 FAIRWAY CIR
Practice Address - Street 2:7-C
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-3622
Practice Address - Country:US
Practice Address - Phone:708-489-2482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist