Provider Demographics
NPI:1376916924
Name:WAHLER, SCOTT (BS, CADC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:WAHLER
Suffix:
Gender:M
Credentials:BS, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-2717
Mailing Address - Country:US
Mailing Address - Phone:847-634-6422
Mailing Address - Fax:
Practice Address - Street 1:2900 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-2717
Practice Address - Country:US
Practice Address - Phone:847-634-6422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3768101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)