Provider Demographics
NPI:1487034963
Name:SKOG, JESSIE ANNE
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:ANNE
Last Name:SKOG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:
Other - Last Name:ZILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:333 MAGAZINE ST
Mailing Address - Street 2:SUITE #3
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-1867
Mailing Address - Country:US
Mailing Address - Phone:906-632-3277
Mailing Address - Fax:906-632-3277
Practice Address - Street 1:333 MAGAZINE ST
Practice Address - Street 2:SUITE #3
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-1867
Practice Address - Country:US
Practice Address - Phone:906-632-3277
Practice Address - Fax:906-253-1069
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000701231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist