Provider Demographics
NPI:1770972028
Name:BURGESS, SCOTT PAUL
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:PAUL
Last Name:BURGESS
Suffix:
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 1:1786 MOON LAKE BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1016
Mailing Address - Country:US
Mailing Address - Phone:847-755-8090
Mailing Address - Fax:
Practice Address - Street 1:1786 MOON LAKE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1016
Practice Address - Country:US
Practice Address - Phone:847-755-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-09
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker