Provider Demographics
NPI:1043927486
Name:SKOGLUND, DEAN CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:CHRISTOPHER
Last Name:SKOGLUND
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 1:6249 ELDERBERRY WINE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89142-0944
Mailing Address - Country:US
Mailing Address - Phone:702-271-9295
Mailing Address - Fax:
Practice Address - Street 1:8020 W SAHARA AVE STE 125
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7917
Practice Address - Country:US
Practice Address - Phone:170-247-0062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician