Provider Demographics
NPI:1376975136
Name:SKOUG, LINDA WRIGHT (LPC)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:WRIGHT
Last Name:SKOUG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19207 N 67TH DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5708
Mailing Address - Country:US
Mailing Address - Phone:623-210-2573
Mailing Address - Fax:
Practice Address - Street 1:615 S 8TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-4463
Practice Address - Country:US
Practice Address - Phone:920-323-7742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2551-125101YP2500X
AZLAC-12814101YP2500X
07-087221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist