Provider Demographics
NPI:1134291016
Name:SKULSTAD, JENNIE LOUISE GORRES (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:LOUISE GORRES
Last Name:SKULSTAD
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:JENNIE
Other - Middle Name:LOUISE
Other - Last Name:GORRES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LMFT
Mailing Address - Street 1:4505 DREW AVE. N
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422
Mailing Address - Country:US
Mailing Address - Phone:763-473-1729
Mailing Address - Fax:
Practice Address - Street 1:7575 GOLDEN VALLEY RD
Practice Address - Street 2:SUITE 305
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4562
Practice Address - Country:US
Practice Address - Phone:763-227-5528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1046106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist