Healthcare Provider Details

I. General information

NPI: 1508339714
Provider Name (Legal Business Name): ELIZABETH RENEHAN SKOGLUND LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4697 MAIN ST FL 1
MANCHESTER CENTER VT
05255-8945
US

IV. Provider business mailing address

PO BOX 561
DORSET VT
05251-0561
US

V. Phone/Fax

Practice location:
  • Phone: 802-949-0726
  • Fax:
Mailing address:
  • Phone: 802-949-0726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number3483
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0134405
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: