Healthcare Provider Details

I. General information

NPI: 1891395174
Provider Name (Legal Business Name): MICHAEL ROBERT SKAGGS LPCT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8618 US HIGHWAY 51 N
MINOCQUA WI
54548-9347
US

IV. Provider business mailing address

8618 US HIGHWAY 51 N
MINOCQUA WI
54548-9347
US

V. Phone/Fax

Practice location:
  • Phone: 715-356-6146
  • Fax:
Mailing address:
  • Phone: 715-356-6146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4794-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: