Provider Demographics
NPI:1740440924
Name:SCOTT L FENTON, PSYD, LLC
Entity type:Organization
Organization Name:SCOTT L FENTON, PSYD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:L
Authorized Official - Last Name:FENTON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:608-628-3963
Mailing Address - Street 1:5900 MONONA DR STE 408
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-3561
Mailing Address - Country:US
Mailing Address - Phone:608-628-3963
Mailing Address - Fax:608-501-0978
Practice Address - Street 1:5900 MONONA DR STE 408
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-3561
Practice Address - Country:US
Practice Address - Phone:608-628-3963
Practice Address - Fax:608-501-0978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2531057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty