Provider Demographics
NPI:1891973590
Name:SCOTT, LESLIE TERRESE (LCSW, CEAP)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:TERRESE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LCSW, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2495 N RODGERS AVE
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-4852
Mailing Address - Country:US
Mailing Address - Phone:618-550-3346
Mailing Address - Fax:618-462-9946
Practice Address - Street 1:2495 N RODGERS AVE
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4852
Practice Address - Country:US
Practice Address - Phone:618-550-3346
Practice Address - Fax:618-462-4393
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490124861041C0700X
MO20040078051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical