Provider Demographics
NPI:1043765423
Name:SCOTT, LINDA ROSE
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ROSE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:SCOTT
Other - Last Name:ZELLARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICDC-CS
Mailing Address - Street 1:4531 READING RD
Mailing Address - Street 2:FATHERHOOD PROJECT
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-1229
Mailing Address - Country:US
Mailing Address - Phone:513-961-3292
Mailing Address - Fax:513-961-3349
Practice Address - Street 1:4531 READING RD
Practice Address - Street 2:FATHERHOOD PROJECT
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-1229
Practice Address - Country:US
Practice Address - Phone:513-961-3292
Practice Address - Fax:513-961-3349
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH882482101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH882482OtherLICDC-CS