Provider Demographics
NPI:1720355811
Name:SKRUPKY, ANNE (MSE,PCTL, SACIT)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:SKRUPKY
Suffix:
Gender:F
Credentials:MSE,PCTL, SACIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-1208
Mailing Address - Country:US
Mailing Address - Phone:920-231-0143
Mailing Address - Fax:920-231-4246
Practice Address - Street 1:3240 JACKSON ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-1208
Practice Address - Country:US
Practice Address - Phone:920-231-0143
Practice Address - Fax:920-231-4246
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16249-130101YA0400X
WI932-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)