Basic Information
| Provider Information | |||||||||
| NPI: | 1134600455 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCALLON | ||||||||
| FirstName: | BETSY | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1161 LAKE COOK RD | ||||||||
| Address2: | |||||||||
| City: | DEERFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600155649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474985437 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3113 W BELTLINE HWY STE 300 | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537132934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088196810 | ||||||||
| FaxNumber: | 6088196811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2018 | ||||||||
| LastUpdateDate: | 08/24/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 2558-123 | WI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.