Provider Demographics
NPI:1073175592
Name:SHOLLENBARGER, SKYLER G (PHD)
Entity Type:Individual
Prefix:DR
First Name:SKYLER
Middle Name:G
Last Name:SHOLLENBARGER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 CRETIN AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1311
Mailing Address - Country:US
Mailing Address - Phone:513-602-2597
Mailing Address - Fax:
Practice Address - Street 1:7301 OHMS LN STE 450
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2339
Practice Address - Country:US
Practice Address - Phone:952-831-2000
Practice Address - Fax:952-835-6134
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-04
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301018403103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical