1609933498 NPI number — DR. BARBARA SKODJE-MACK EDD, LMFT, LPCC

Table of content: (NPI 1417171828)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609933498 NPI number — DR. BARBARA SKODJE-MACK EDD, LMFT, LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SKODJE-MACK
Provider First Name:
BARBARA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
EDD, LMFT, LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609933498
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 CENTRACARE CIR STE 1000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT CLOUD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56303-5000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-229-4945
Provider Business Mailing Address Fax Number:
320-229-5141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 CENTRACARE CIR STE 1000
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT CLOUD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56303-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-229-5199
Provider Business Practice Location Address Fax Number:
202-295-1413
Provider Enumeration Date:
01/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  98 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 1417 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01044729 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 136391 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 098402000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 155H2SK . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP56449 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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