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Individual
MR. SCOTT STANGE
Active
Individual
MR. SCOTT STANGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
149-006942
IL
1041C0700X
Clinical Social Worker
149006942
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149006942
BLUE CROSS ILLINOIS NUMBE
IL
01
—
99254
BLUE CROSS IOWA
IL
01
—
JB420B1
JOHN DEERE PROVIDER NUMB
IL
Enumeration date
08/26/2005
Last updated
09/08/2023
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