Provider Demographics
NPI:1215276969
Name:SCOTT, KIMBERLY ENDERS (MED, MA, LLP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ENDERS
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MED, MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16449 GRILLO DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-4007
Mailing Address - Country:US
Mailing Address - Phone:586-201-9420
Mailing Address - Fax:
Practice Address - Street 1:1000 W UNIVERSITY DR STE 308
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1876
Practice Address - Country:US
Practice Address - Phone:248-923-2099
Practice Address - Fax:248-923-2096
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014023103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist