Provider Demographics
NPI:1386090363
Name:MONIEA SKLUZACEK, JULIE (MAOM, LAC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MONIEA SKLUZACEK
Suffix:
Gender:F
Credentials:MAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57280 GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55063-9372
Mailing Address - Country:US
Mailing Address - Phone:320-980-7851
Mailing Address - Fax:
Practice Address - Street 1:57280 GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:MN
Practice Address - Zip Code:55063-9372
Practice Address - Country:US
Practice Address - Phone:320-980-7851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist