MEDICARE: MICHELLE SUE SKAU LCPC

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	101YP2500X	Professional Counselor	180-005070	IL
2	101YP2500X	Professional Counselor	4342-125	WI

General Provider Information

NPI Number	:	1902912744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE SUE SKAU LCPC

Provider Business Mailing Address
First Line	:	300 4TH STREET NORTH
Second Line	:
City	:	LA CROSSE
State	:	WI
Zip	:	54602-4002
Country	:	US
Telephone Number	:	608-785-6101
Fax Number	:	608-793-6560

Provider Business Practice Location Address
First Line	:	300 4TH STREET NORTH
Second Line	:
City	:	LA CROSSE
State	:	WI
Zip	:	54602-4002
Country	:	US
Telephone Number	:	815-732-3157
Fax Number	:

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	09/30/2010

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