Provider Demographics
NPI:1407062599
Name:SCANLAN, CARA ANN (MS MFT)
Entity type:Individual
Prefix:MRS
First Name:CARA
Middle Name:ANN
Last Name:SCANLAN
Suffix:
Gender:F
Credentials:MS MFT
Other - Prefix:MISS
Other - First Name:CARA
Other - Middle Name:ANN
Other - Last Name:SHORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:602 PLEASANT OAK DR
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:WI
Mailing Address - Zip Code:53575-3282
Mailing Address - Country:US
Mailing Address - Phone:608-835-5050
Mailing Address - Fax:
Practice Address - Street 1:602 PLEASANT OAK DR
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:WI
Practice Address - Zip Code:53575-3282
Practice Address - Country:US
Practice Address - Phone:608-835-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI47-228OtherMFT TRAINING LICENSE