Scott Fisk, LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

304279 Issued in MN

Practice address

11367 Quince St NW
Coon Rapids, MN 55448-3246

Phone

(763) 614-8381

NPI assigned

Feb 18, 2025

Last updated

Feb 18, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2017

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Life Interrupted Counseling Services

  • Adolescent and Children Mental Health Clinic/Center
  • Burnsville, MN
  • NPI 1033821632
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1739836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739836800000",
    "number": "1962207407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11367 QUINCE ST NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554483246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11367 QUINCE ST NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554483246",
            "telephone_number": "763-614-8381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISK",
        "first_name": "SCOTT",
        "credential": "LADC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-02-18",
        "last_updated": "2025-02-18",
        "certification_date": "2025-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "304279",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lynell Finstad, CRNA
• Jon Fish, CRNA
• Stephanie Fish, LMFT
• Gabrielle Kristine Fisk
• Laurie J. Fisk, FNP-C
• Mary C Flanagan, CRNA
• Terra Rae Fleming, D.C.
• Taylor Ann Flemming
• Abigail Fletcher
• Danielle Fletcher, MSW, LICSW

• Addiction (Substance Use Disorder) Counselor in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.