Provider Demographics
NPI:1699752139
Name:SKILLON, CEDRIC J
Entity type:Individual
Prefix:
First Name:CEDRIC
Middle Name:J
Last Name:SKILLON
Suffix:
Gender:M
Credentials:
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Other - Last Name:
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Mailing Address - Street 1:6465 WAYZATA BLVD
Mailing Address - Street 2:STE 315
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1728
Mailing Address - Country:US
Mailing Address - Phone:952-993-7169
Mailing Address - Fax:952-993-0300
Practice Address - Street 1:2001 BLAISDELL AVE
Practice Address - Street 2:PARK NICOLLET CLINIC - MINNEAPOLIS
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-2414
Practice Address - Country:US
Practice Address - Phone:952-993-8011
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN480492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry