Doctor Name: | MISS SHELLEY ANN SKARDA |
NPI Number: | 1407149396 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | B.S. LADC |
License Number: | 302565 |
Business Practice Address: | 17305 Meadow Creek Lane Pine City, MN - 55063 |
Business Phone Number: | 7634444838 |
Business Fax Number: | |
Mailing Address: | 108h South Dr, CIRCLE PINES |
State: | MN |
Postal Code: | 550143309 |
Phone Number: | 6127351066 |
Fax Number: | |
NPI Enumeration Date: | 05/25/2011 |
NPI Last Update Date: | 05/25/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 302565 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |