Provider Demographics
NPI:1972851905
Name:SCOTT, ED JAY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ED
Middle Name:JAY
Last Name:SCOTT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E MORGAN ST
Mailing Address - Street 2:P.O. BOX 1304
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62651
Mailing Address - Country:US
Mailing Address - Phone:217-245-1655
Mailing Address - Fax:217-245-4742
Practice Address - Street 1:201 E MORGAN ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-2587
Practice Address - Country:US
Practice Address - Phone:217-245-1655
Practice Address - Fax:217-245-4742
Is Sole Proprietor?:No
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0031731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical