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General NPI Number Information
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NPI Number | 1033715735
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Entity Type | Individual
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Provider Name | CASSIE J. SKALICKY
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Gender | Female
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Dates
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Enumeration Date | 12/08/2020
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 505 BROADWAY N STE 206
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City | FARGO
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State | ND
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Zip | 58102-4489
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Country | US
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Telephone | 701-356-7836
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Fax |
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Provider Business Mailing Address
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Address Line | 4410 SUNRISE DR
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City | WEST FARGO
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State | ND
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Zip | 58078-8296
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Country | US
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Telephone | 701-405-3838
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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