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General NPI Number Information
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NPI Number | 1194187955
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Entity Type | Individual
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Provider Name | PEGGY SUE SKOLD CSAC
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Gender | Female
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 03/22/2016
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Provider Practice Location Address
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Address Line | 24248 STATE ROAD 35 70 UNIT D
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City | SIREN
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State | WI
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Zip | 54872-5001
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Country | US
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Telephone | 715-349-7233
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Fax | 715-349-7205
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Provider Business Mailing Address
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Address Line | 108 W 2ND ST N
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City | LADYSMITH
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State | WI
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Zip | 54848-1338
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Country | US
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Telephone | 715-532-9771
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Fax | 715-532-9774
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 15863-132
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License Number State | WI
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