Provider Demographics
NPI:1801917927
Name:SKURDAL, MARLO A (PSYCHOLOGIST,MA,LP)
Entity type:Individual
Prefix:MR
First Name:MARLO
Middle Name:A
Last Name:SKURDAL
Suffix:
Gender:M
Credentials:PSYCHOLOGIST,MA,LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 STONY POINT RD.
Mailing Address - Street 2:
Mailing Address - City:COURTLAND
Mailing Address - State:MN
Mailing Address - Zip Code:56021-9738
Mailing Address - Country:US
Mailing Address - Phone:507-359-5439
Mailing Address - Fax:
Practice Address - Street 1:122 STONY POINT RD
Practice Address - Street 2:
Practice Address - City:COURTLAND
Practice Address - State:MN
Practice Address - Zip Code:56021-9738
Practice Address - Country:US
Practice Address - Phone:507-359-5439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2273103T00000X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service