MEDICARE: MRS. JULIE RAE SKOKAN MACCCSLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	7330	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4600617	OTHER	MN	MEDICA
2	89G61SK	OTHER	MN	BLUE CROSS BLUE SHIELD MN

General Provider Information

NPI Number	:	1326143850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIE RAE SKOKAN MACCCSLP

Provider Business Mailing Address
First Line	:	8056 INGLESIDE AVE S
Second Line	:
City	:	COTTAGE GROVE
State	:	MN
Zip	:	55016-3233
Country	:	US
Telephone Number	:	651-768-0115
Fax Number	:

Provider Business Practice Location Address
First Line	:	5842 BLACKSHIRE PATH
Second Line	:	SUITE 201
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-1619
Country	:	US
Telephone Number	:	651-554-9940
Fax Number	:	651-554-9941

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	07/08/2007

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