Provider Demographics
NPI:1093303968
Name:SCOTT, ANGELA DAWN (LSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DAWN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 GRASMERE AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-2850
Mailing Address - Country:US
Mailing Address - Phone:419-565-8144
Mailing Address - Fax:
Practice Address - Street 1:1012 ODNR MOHICAN 51
Practice Address - Street 2:
Practice Address - City:PERRYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44864-9407
Practice Address - Country:US
Practice Address - Phone:419-994-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0600420104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker