Provider Demographics
NPI:1811627722
Name:SCOTT, KELLY ANN (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:CUSTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:5506 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-2619
Mailing Address - Country:US
Mailing Address - Phone:303-475-1338
Mailing Address - Fax:
Practice Address - Street 1:1500 EISENHOWER LN STE 900
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-2135
Practice Address - Country:US
Practice Address - Phone:630-328-0118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical