Provider Demographics
NPI:1538963145
Name:SKOGLUND, MARY (RDN, LD, CDCES)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SKOGLUND
Suffix:
Gender:
Credentials:RDN, LD, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 BRENT DR
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-8519
Mailing Address - Country:US
Mailing Address - Phone:208-503-3832
Mailing Address - Fax:
Practice Address - Street 1:753 BRENT DR
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-8519
Practice Address - Country:US
Practice Address - Phone:208-503-3832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered