Healthcare Provider Details

I. General information

NPI: 1861509077
Provider Name (Legal Business Name): STEPHEN W SKOWLUND LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 GARDNER AVE #3
BURLINGTON WI
53105-2160
US

IV. Provider business mailing address

3301 W FOREST HOME AVE
MILWAUKEE WI
53215-2843
US

V. Phone/Fax

Practice location:
  • Phone: 262-763-7766
  • Fax: 262-763-9326
Mailing address:
  • Phone: 414-647-6326
  • Fax: 414-671-8860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3861-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: