Healthcare Provider Details

I. General information

NPI: 1790376416
Provider Name (Legal Business Name): JULIE SKOKNA RN LCPC NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5446 S MADISON AVE
COUNTRYSIDE IL
60525-2857
US

IV. Provider business mailing address

5446 S MADISON AVE
COUNTRYSIDE IL
60525-2857
US

V. Phone/Fax

Practice location:
  • Phone: 708-546-7763
  • Fax:
Mailing address:
  • Phone: 708-546-7763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number180.013380
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.219702
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180013380
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: