Provider Demographics
NPI:1992329072
Name:HEDGE, SCOTT (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:HEDGE
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5780 W 76TH PL APT 3C
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-3224
Mailing Address - Country:US
Mailing Address - Phone:708-745-2730
Mailing Address - Fax:
Practice Address - Street 1:5780 W 76TH PL APT 3C
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-3224
Practice Address - Country:US
Practice Address - Phone:708-745-2730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490212901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical