Provider Demographics
NPI:1386745214
Name:SKOGSTROM, HELEN R (PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:R
Last Name:SKOGSTROM
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 S SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2921
Mailing Address - Country:US
Mailing Address - Phone:937-382-5515
Mailing Address - Fax:937-289-3424
Practice Address - Street 1:925 S SOUTH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2921
Practice Address - Country:US
Practice Address - Phone:937-382-5515
Practice Address - Fax:937-289-3424
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14394101YM0800X
OH2179103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2179OtherPSYCHOLOG.LICENSE
OH0524061Medicaid
14394OtherNAT'LBDCERTCOUNSELORS
OH2179OtherPSYCHOLOG.LICENSE