Provider Demographics
NPI:1821292186
Name:SKOOG, LORI MICHELLE (BAPSYCHOLOGY)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:MICHELLE
Last Name:SKOOG
Suffix:
Gender:F
Credentials:BAPSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34542 MAFFITT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:IA
Mailing Address - Zip Code:50051-0000
Mailing Address - Country:US
Mailing Address - Phone:515-491-1903
Mailing Address - Fax:515-953-5456
Practice Address - Street 1:34542 MAFFITT LAKE RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:IA
Practice Address - Zip Code:50051-0000
Practice Address - Country:US
Practice Address - Phone:515-491-1903
Practice Address - Fax:515-953-5456
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0763672101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor