Healthcare Provider Details

I. General information

NPI: 1386745214
Provider Name (Legal Business Name): HELEN R. SKOGSTROM PSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 S SOUTH ST
WILMINGTON OH
45177-2921
US

IV. Provider business mailing address

925 S SOUTH ST
WILMINGTON OH
45177-2921
US

V. Phone/Fax

Practice location:
  • Phone: 937-382-5515
  • Fax: 937-289-3424
Mailing address:
  • Phone: 937-382-5515
  • Fax: 937-289-3424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14394
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2179
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: