Provider Demographics
NPI:1083742738
Name:SKOGMO, JERRY (LCPC)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:SKOGMO
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 W DUNDEE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-4006
Mailing Address - Country:US
Mailing Address - Phone:847-634-8883
Mailing Address - Fax:847-821-0065
Practice Address - Street 1:1501 W DUNDEE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-4006
Practice Address - Country:US
Practice Address - Phone:847-634-8883
Practice Address - Fax:847-821-0065
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional