Provider Demographics
NPI:1326143850
Name:SKOKAN, JULIE RAE (MACCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:RAE
Last Name:SKOKAN
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8056 INGLESIDE AVE S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-3233
Mailing Address - Country:US
Mailing Address - Phone:651-768-0115
Mailing Address - Fax:
Practice Address - Street 1:5842 BLACKSHIRE PATH
Practice Address - Street 2:SUITE 201
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-1619
Practice Address - Country:US
Practice Address - Phone:651-554-9940
Practice Address - Fax:651-554-9941
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7330235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4600617OtherMEDICA
MN89G61SKOtherBLUE CROSS BLUE SHIELD MN