Provider Demographics
NPI:1093415432
Name:SCOTT, SIMONE RENEA
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:RENEA
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5559 WILLOWOOD CT
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-6735
Mailing Address - Country:US
Mailing Address - Phone:419-810-6560
Mailing Address - Fax:
Practice Address - Street 1:5559 WILLOWOOD CT
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-6735
Practice Address - Country:US
Practice Address - Phone:419-810-6560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities