Provider Demographics
NPI:1023265220
Name:SKOG, JACQUELINE J (MA)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:J
Last Name:SKOG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1935 COUNTY ROAD B2 W
Mailing Address - Street 2:SUITE 57
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55113-2729
Mailing Address - Country:US
Mailing Address - Phone:651-528-6400
Mailing Address - Fax:651-528-6400
Practice Address - Street 1:1935 COUNTY ROAD B2 W
Practice Address - Street 2:SUITE 57
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55113-2729
Practice Address - Country:US
Practice Address - Phone:651-528-6400
Practice Address - Fax:651-528-6400
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health