Provider Demographics
NPI:1518270875
Name:LETTOW, SCOTT (CST, CFA)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:LETTOW
Suffix:
Gender:M
Credentials:CST, CFA
Other - Prefix:MR
Other - First Name:SCOTT
Other - Middle Name:ALAN
Other - Last Name:LETTOW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SCOTT LETTOW
Mailing Address - Street 1:9222 EWING #302
Mailing Address - Street 2:
Mailing Address - City:EVANSTION
Mailing Address - State:IL
Mailing Address - Zip Code:60203
Mailing Address - Country:US
Mailing Address - Phone:773-405-1727
Mailing Address - Fax:
Practice Address - Street 1:9222 EWING AVE UNIT 302
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60203-1717
Practice Address - Country:US
Practice Address - Phone:773-405-1727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000259246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist