Provider Demographics
NPI:1417487471
Name:SCOTT, JACK (PHD, CCC-A, F-AAA)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:
Last Name:SCOTT
Suffix:
Gender:M
Credentials:PHD, CCC-A, F-AAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 CAMPUS DRIVE NUCASLL
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60208-0001
Mailing Address - Country:US
Mailing Address - Phone:847-491-3165
Mailing Address - Fax:
Practice Address - Street 1:2315 CAMPUS DRIVE NUCASLL
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60208-0001
Practice Address - Country:US
Practice Address - Phone:847-491-3165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147.001622231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist