Provider Demographics
NPI:1922423714
Name:MALMSKOG, JUDITH ANN (LICSW)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:MALMSKOG
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:A
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LADC
Mailing Address - Street 1:107 1/2 ROBERTS ST N APT 3
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-4951
Mailing Address - Country:US
Mailing Address - Phone:218-640-5781
Mailing Address - Fax:218-250-7926
Practice Address - Street 1:22690 GOOSE DR
Practice Address - Street 2:
Practice Address - City:AKELEY
Practice Address - State:MN
Practice Address - Zip Code:56433-8027
Practice Address - Country:US
Practice Address - Phone:218-366-0911
Practice Address - Fax:218-250-7926
Is Sole Proprietor?:No
Enumeration Date:2014-03-03
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN182251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical