Provider Demographics
NPI:1669679395
Name:LIGHTBODY, SCOT WILLIAM (HIS)
Entity Type:Individual
Prefix:
First Name:SCOT
Middle Name:WILLIAM
Last Name:LIGHTBODY
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24W620 EUGENIA DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-3836
Mailing Address - Country:US
Mailing Address - Phone:630-580-5777
Mailing Address - Fax:
Practice Address - Street 1:55 E LOOP RD
Practice Address - Street 2:SUITE 204
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-2038
Practice Address - Country:US
Practice Address - Phone:630-580-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1753654237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist