Doctor Name: | JERRY SKOGMO |
NPI Number: | 1083742738 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCPC |
License Number: | |
Business Practice Address: | 1501 W Dundee Rd Suite 106 Buffalo Grove, IL - 600894006 |
Business Phone Number: | 8476348883 |
Business Fax Number: | 8478210065 |
Mailing Address: | 1501 W Dundee Rd, Suite 106 BUFFALO GROVE |
State: | IL |
Postal Code: | 600894006 |
Phone Number: | 8476348883 |
Fax Number: | 8478210065 |
NPI Enumeration Date: | 03/02/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |