Provider Demographics
NPI:1871008250
Name:SCOTT, MITZI VANNETTE (CADC)
Entity Type:Individual
Prefix:
First Name:MITZI
Middle Name:VANNETTE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 S KOSTNER AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-1100
Mailing Address - Country:US
Mailing Address - Phone:773-224-7386
Mailing Address - Fax:773-224-7685
Practice Address - Street 1:7601 S KOSTNER AVE STE 500
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652-1100
Practice Address - Country:US
Practice Address - Phone:773-224-7386
Practice Address - Fax:773-224-7685
Is Sole Proprietor?:No
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)