Provider Demographics
NPI:1316770183
Name:WELLE, SKYLAR
Entity type:Individual
Prefix:
First Name:SKYLAR
Middle Name:
Last Name:WELLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7062 BROWNS LN
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-6041
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11010 PRAIRIE LAKES DR STE 350
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3801
Practice Address - Country:US
Practice Address - Phone:952-746-2522
Practice Address - Fax:952-746-0997
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional