Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
Y | 103G00000X | Clinical Psychologist | 20041468A | IN |
Y | 103TC0700X | Clinical Psychologist | 20041468A | IN |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | ||
N | 103TS0200X | School Psychologist |
NPI | 1194066019 |
---|---|
Provider Name | Marilyn C Scott |
First Address | Homewood, IL 60430 |
Second Address | Hazel Crest, IL 60429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2013 |
Last Update Date | 04/03/2013 |