Provider Demographics
NPI:1396197802
Name:SCOTT, LAUREN (LLMSW)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 36TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-2809
Mailing Address - Country:US
Mailing Address - Phone:616-726-1967
Mailing Address - Fax:616-954-3541
Practice Address - Street 1:3333 36TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-2809
Practice Address - Country:US
Practice Address - Phone:616-726-1967
Practice Address - Fax:616-954-3541
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801101883104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker