Provider Demographics
NPI:1407149396
Name:SKARDA, SHELLEY ANN (BS LADC)
Entity Type:Individual
Prefix:MISS
First Name:SHELLEY
Middle Name:ANN
Last Name:SKARDA
Suffix:
Gender:F
Credentials:BS LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108H SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:CIRCLE PINES
Mailing Address - State:MN
Mailing Address - Zip Code:55014-3309
Mailing Address - Country:US
Mailing Address - Phone:612-735-1066
Mailing Address - Fax:
Practice Address - Street 1:17305 MEADOW CREEK LANE
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:MN
Practice Address - Zip Code:55063
Practice Address - Country:US
Practice Address - Phone:763-444-4838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302565101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)