Provider Demographics
NPI:1861362790
Name:ANDERSON, SKYLAR JEAN
Entity type:Individual
Prefix:
First Name:SKYLAR
Middle Name:JEAN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7272 HAWK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GRASSTON
Mailing Address - State:MN
Mailing Address - Zip Code:55030-3156
Mailing Address - Country:US
Mailing Address - Phone:320-298-5159
Mailing Address - Fax:320-298-5159
Practice Address - Street 1:7272 HAWK RIDGE RD
Practice Address - Street 2:
Practice Address - City:GRASSTON
Practice Address - State:MN
Practice Address - Zip Code:55030-3156
Practice Address - Country:US
Practice Address - Phone:320-298-5159
Practice Address - Fax:320-298-5159
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-06
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1128116253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency