Provider Demographics
NPI:1306434618
Name:SCOTT, LEE WILLIAM (LCSW)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:WILLIAM
Last Name:SCOTT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 E LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-3956
Mailing Address - Country:US
Mailing Address - Phone:815-758-6550
Mailing Address - Fax:815-758-4239
Practice Address - Street 1:1701 E LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-3956
Practice Address - Country:US
Practice Address - Phone:815-758-6550
Practice Address - Fax:815-758-4239
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0160921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical