Provider Demographics
NPI:1053540112
Name:SKOVRAN, JULIE (MT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:SKOVRAN
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20170 HUNTINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-9725
Mailing Address - Country:US
Mailing Address - Phone:612-839-2328
Mailing Address - Fax:
Practice Address - Street 1:20170 HUNTINGTON WAY
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-9725
Practice Address - Country:US
Practice Address - Phone:612-839-2328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist