Provider Demographics
NPI:1144586074
Name:SKOGLUND, NAOMI E (LAC)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:E
Last Name:SKOGLUND
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:619 BRIGHTON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2323
Mailing Address - Country:US
Mailing Address - Phone:207-370-1535
Mailing Address - Fax:844-308-4988
Practice Address - Street 1:619 BRIGHTON AVE STE 101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2323
Practice Address - Country:US
Practice Address - Phone:207-370-1535
Practice Address - Fax:844-308-4988
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC533171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist