Healthcare Provider Details

I. General information

NPI: 1164740353
Provider Name (Legal Business Name): HEATHER SKOGEN LBSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 47TH AVE S
GRAND FORKS ND
58201-3405
US

IV. Provider business mailing address

2400 47TH AVE S
GRAND FORKS ND
58201-3405
US

V. Phone/Fax

Practice location:
  • Phone: 701-746-2200
  • Fax:
Mailing address:
  • Phone: 701-746-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4415
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: