Provider Demographics
NPI:1790376416
Name:SKOKNA, JULIE (RN LCPC NCC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:SKOKNA
Suffix:
Gender:F
Credentials:RN LCPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5446 S MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2857
Mailing Address - Country:US
Mailing Address - Phone:708-546-7763
Mailing Address - Fax:
Practice Address - Street 1:5446 S MADISON AVE
Practice Address - Street 2:
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-2857
Practice Address - Country:US
Practice Address - Phone:708-546-7763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.219702163W00000X
IL180013380101YM0800X
IL180.013380101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)