Provider Demographics
NPI:1588098479
Name:SKINNESS, JULIE LYNNE
Entity type:Individual
Prefix:MISS
First Name:JULIE
Middle Name:LYNNE
Last Name:SKINNESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 8TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-1703
Mailing Address - Country:US
Mailing Address - Phone:507-438-1672
Mailing Address - Fax:
Practice Address - Street 1:1803 8TH AVE SW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-1703
Practice Address - Country:US
Practice Address - Phone:507-438-1672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1060170-2-AFC253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency