Provider Demographics
NPI:1730723651
Name:REIN, SCOTT WILLIAM JR
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:WILLIAM
Last Name:REIN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 N OZANAM AVE
Mailing Address - Street 2:
Mailing Address - City:NORRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60706-3201
Mailing Address - Country:US
Mailing Address - Phone:708-921-6047
Mailing Address - Fax:
Practice Address - Street 1:4419 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1021
Practice Address - Country:US
Practice Address - Phone:773-777-7112
Practice Address - Fax:708-547-7732
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178014031101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health