Provider Demographics
NPI:1144572561
Name:SKOLRUD, SELENA LEANNE (MS, SLPCF)
Entity Type:Individual
Prefix:MRS
First Name:SELENA
Middle Name:LEANNE
Last Name:SKOLRUD
Suffix:
Gender:F
Credentials:MS, SLPCF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 BURRELL AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501
Mailing Address - Country:US
Mailing Address - Phone:208-743-4558
Mailing Address - Fax:208-746-7657
Practice Address - Street 1:1014 BURRELL AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-5589
Practice Address - Country:US
Practice Address - Phone:208-743-4558
Practice Address - Fax:208-746-7657
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDTSLP-2213235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist