Provider Demographics
NPI:1831110311
Name:SCOTT, JILL (LCSW)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 MAIN ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-7407
Mailing Address - Country:US
Mailing Address - Phone:303-956-6281
Mailing Address - Fax:
Practice Address - Street 1:1707 MAIN ST
Practice Address - Street 2:SUITE 404
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-7407
Practice Address - Country:US
Practice Address - Phone:303-956-6281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9930151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC496558Medicare PIN