Provider Demographics
NPI:1366319170
Name:SCOTT, TASHA R
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:R
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60046-8971
Mailing Address - Country:US
Mailing Address - Phone:224-214-8378
Mailing Address - Fax:
Practice Address - Street 1:219 VALLEY DR
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-8971
Practice Address - Country:US
Practice Address - Phone:224-214-8378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-17
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver