Provider Demographics
NPI:1245361633
Name:SKOGMO, MELINDA RICHTER (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:RICHTER
Last Name:SKOGMO
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 W DUNDEE RD
Mailing Address - Street 2:SUITE #106
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-4006
Mailing Address - Country:US
Mailing Address - Phone:847-634-8883
Mailing Address - Fax:847-821-0665
Practice Address - Street 1:1501 W DUNDEE RD
Practice Address - Street 2:SUITE #106
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-4006
Practice Address - Country:US
Practice Address - Phone:847-634-8883
Practice Address - Fax:847-821-0665
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL941160Medicare ID - Type Unspecified