Provider Demographics
NPI:1194187955
Name:SKOLD, PEGGY SUE (CSAC)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:SUE
Last Name:SKOLD
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 W 2ND ST N
Mailing Address - Street 2:
Mailing Address - City:LADYSMITH
Mailing Address - State:WI
Mailing Address - Zip Code:54848-1338
Mailing Address - Country:US
Mailing Address - Phone:715-532-9771
Mailing Address - Fax:715-532-9774
Practice Address - Street 1:24248 STATE ROAD 35 70
Practice Address - Street 2:UNIT D
Practice Address - City:SIREN
Practice Address - State:WI
Practice Address - Zip Code:54872-5001
Practice Address - Country:US
Practice Address - Phone:715-349-7233
Practice Address - Fax:715-349-7205
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15863-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)