Provider Demographics
NPI:1356334106
Name:STANGE, SCOTT (LCSW)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:STANGE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 30TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-1942
Mailing Address - Country:US
Mailing Address - Phone:309-235-7644
Mailing Address - Fax:
Practice Address - Street 1:ROCK ISLAND ARSENAL HEALTH CLINIC, (RIAHC)
Practice Address - Street 2:ATTN: MCXM-DMC, BUILDING 110
Practice Address - City:ROCK ISLAND ARSENAL
Practice Address - State:IL
Practice Address - Zip Code:61299-7240
Practice Address - Country:US
Practice Address - Phone:309-782-0805
Practice Address - Fax:309-782-0810
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490069421041C0700X
IL149-006942104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149006942OtherBLUE CROSS ILLINOIS NUMBE
IL99254OtherBLUE CROSS IOWA
ILJB420B1OtherJOHN DEERE PROVIDER NUMB