Healthcare Provider Details

I. General information

NPI: 1881095602
Provider Name (Legal Business Name): JENNIFER SUSAN SKAVHAUG M.A., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10007 LEE ST
EAGLE RIVER AK
99577-8354
US

IV. Provider business mailing address

10007 LEE ST
EAGLE RIVER AK
99577-8354
US

V. Phone/Fax

Practice location:
  • Phone: 907-444-6693
  • Fax: 417-374-0271
Mailing address:
  • Phone: 907-444-6693
  • Fax: 417-374-0271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2017009310
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number177749
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: