Provider Demographics
NPI:1487995312
Name:SKUBAL, MARY THERESA (MS, CVE, CRC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:THERESA
Last Name:SKUBAL
Suffix:
Gender:F
Credentials:MS, CVE, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:PO BOX 120501
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55112-0019
Mailing Address - Country:US
Mailing Address - Phone:952-922-6907
Mailing Address - Fax:651-484-2356
Practice Address - Street 1:3550 LEXINGTON AVE N
Practice Address - Street 2:SUITE 205
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55126-8075
Practice Address - Country:US
Practice Address - Phone:952-922-6907
Practice Address - Fax:651-484-2356
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor