Provider Demographics
NPI:1235488966
Name:SKATTUM, LORI J (SLP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:J
Last Name:SKATTUM
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:J
Other - Last Name:BENKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 S COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4036
Mailing Address - Country:US
Mailing Address - Phone:701-780-5000
Mailing Address - Fax:701-780-5772
Practice Address - Street 1:1300 S COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4012
Practice Address - Country:US
Practice Address - Phone:701-780-2300
Practice Address - Fax:701-780-5772
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1218235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist