Provider Demographics
NPI:1952687063
Name:SKILLINGSTAD, LINDA MARIE (LICSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:SKILLINGSTAD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5544 COLFAX AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-1746
Mailing Address - Country:US
Mailing Address - Phone:612-822-2340
Mailing Address - Fax:
Practice Address - Street 1:12915 63RD AVE N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-6001
Practice Address - Country:US
Practice Address - Phone:952-826-8376
Practice Address - Fax:763-383-5801
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN89221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical