Provider Demographics
NPI:1093111973
Name:GAGNON SKILLICORN, JULIE (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:GAGNON SKILLICORN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 CASCADE ST
Mailing Address - Street 2:
Mailing Address - City:LOLO
Mailing Address - State:MT
Mailing Address - Zip Code:59847-9613
Mailing Address - Country:US
Mailing Address - Phone:406-396-0197
Mailing Address - Fax:
Practice Address - Street 1:1836 SOUTH AVE W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6510
Practice Address - Country:US
Practice Address - Phone:406-396-0197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT87601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical