Provider Demographics
NPI:1659315539
Name:SCOTT, MEADOW MARIE (LICSW, LIMHP)
Entity Type:Individual
Prefix:MRS
First Name:MEADOW
Middle Name:MARIE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LICSW, LIMHP
Other - Prefix:MISS
Other - First Name:MEADOW
Other - Middle Name:MARIE
Other - Last Name:ROUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 E 23RD ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2393
Mailing Address - Country:US
Mailing Address - Phone:402-995-9989
Mailing Address - Fax:
Practice Address - Street 1:415 E 23RD ST
Practice Address - Street 2:SUITE 205
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2393
Practice Address - Country:US
Practice Address - Phone:402-995-9989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2549101YP2500X
NE10651041C0700X
NE651174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10024965800Medicaid
NE10024965800Medicaid