JOHNATHAN SKOOG (NPI# 1114544152) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114544152 |
| Entity Type | Individual |
| Full Name | JOHNATHAN SKOOG |
| Practice Address |
591 S Knik Goose Bay Rd Wasilla AK 99654-8062 |
| Practice Telephone | 9073131333 |
| Practice Fax Number | 9073578781 |
| Mailing Telephone | 9073131333 |
| Mailing Fax Number | 9073578781 |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2020-06-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | Other Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 545 S Knik Goose Bay Rd, Wasilla, AK 996548171 | 9073131333 |
| Street Address |
591 S KNIK GOOSE BAY RD |
| City | WASILLA |
| State | AK |
| Zip Code | 99654-8062 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558806604 | Brandy Stevens | Counselor | 591 S Knik Goose Bay Rd, Wasilla, AK 99654-8062 | 2016-12-28 |
| 1912506098 | Christopher Johnson | Peer Specialist | 591 S Knik Goose Bay Rd, Wasilla, AK 99654-8062 | 2020-10-20 |
| 1003420183 | Brittany Lynne Russell | Peer Specialist | 591 S Knik Goose Bay Rd, Wasilla, AK 99654-8062 | 2020-09-04 |
| 1518578020 | Holly A Hoff | Counselor | 591 S Knik Goose Bay Rd, Wasilla, AK 99654-8062 | 2020-08-10 |
| 1508476268 | Kenneth Dwayne Neill | Peer Specialist | 591 S Knik Goose Bay Rd, Wasilla, AK 99654-8062 | 2020-08-06 |
| 1427673425 | Hannah Rogers | Peer Specialist | 591 S Knik Goose Bay Rd, Wasilla, AK 99654-8062 | 2020-06-15 |
| 1114542677 | Anne Benson | Peer Specialist | 591 S Knik Goose Bay Rd, Wasilla, AK 99654-8062 | 2020-06-10 |
| 1942829460 | True North Recovery Inc. | Substance Abuse Rehabilitation Facility | 591 S Knik Goose Bay Rd, Wasilla, AK 99654-8062 | 2020-04-14 |
| 1912530197 | Sean Morton | Peer Specialist | 591 S Knik Goose Bay Rd, Wasilla, AK 99654-8062 | 2020-02-17 |
| 1568093078 | Leslie Gail Sharpe | Case Manager/Care Coordinator | 591 S Knik Goose Bay Rd, Wasilla, AK 99654-8062 | 2020-02-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003426784 | Colleen Maggie Newcity | Case Manager/Care Coordinator | 851 Westpoint Suite 310, Wasilla, AK 99654 | 2020-08-06 |
| 1659995884 | Amy M Lowe | Peer Specialist | 1363 W Spuce Ave, Wasilla, AK 99654 | 2020-06-03 |
| 1922648690 | Achieve Medical Alaska LLC | Clinic/Center | 1981 E Palmer, Suite 230, Wasilla, AK 99654 | 2020-01-10 |
| 1588205538 | Juan Carlos Garcia | Physician Assistant | 950 East Bogard Road, Suite 103, Wasilla, AK 99654 | 2019-10-01 |
| 1427610864 | Sharon Webb | Counselor | 705 S Knik Goose Bay Rd Suite K, Wasilla, AK 99654 | 2019-07-06 |
| 1306401864 | Logan Lee Cook | Peer Specialist | 2953 E Fairview Loop, Wasilla, AK 99654 | 2019-05-09 |
| 1053883595 | Moose Creek Medical Clinic LLC | Nurse Practitioner | 2341 S. Fern St., Suite 300, Wasilla, AK 99654 | 2018-12-21 |
| 1487124962 | Melissa A Stevens | Massage Therapist | 2201 W That Rd, Wasilla, AK 99654 | 2018-11-28 |
| 1609359561 | Audrey E Beers | Midwife | 2405 S. Knik Goose Bay Rd., Wasilla, AK 99654 | 2018-09-07 |
| 1093297418 | Karlee Janine Mccorry | Occupational Therapist | 613 S Knik-goose Bay Rd, Wasilla, AK 99654 | 2018-09-01 |
| Find all providers in zip 99654 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215552526 | Joshua Dee Engle | Peer Specialist | 1419 S Kittiwake St, Wasilla, AK 99623-9302 | 2020-06-11 |
| 1659995884 | Amy M Lowe | Peer Specialist | 1363 W Spuce Ave, Wasilla, AK 99654 | 2020-06-03 |
| 1104449800 | Aubrey Danielle Cave | Peer Specialist | 5752 W Kranberry Ln, Wasilla, AK 99623-1050 | 2020-05-28 |
| 1629610563 | Mikko Joseph Barribeau | Peer Specialist | 2762 N Azurite Cir, Wasilla, AK 99654-4540 | 2019-10-11 |
| 1306401864 | Logan Lee Cook | Peer Specialist | 2953 E Fairview Loop, Wasilla, AK 99654 | 2019-05-09 |
| 1376107979 | John Zaakery Wilson | Peer Specialist | 3350 E Beech Way # A, Wasilla, AK 99654-7417 | 2019-04-29 |
| 1912506098 | Christopher Johnson | Peer Specialist | 591 S Knik Goose Bay Rd, Wasilla, AK 99654-8062 | 2020-10-20 |
| 1497353874 | Brianne Jean Bird | Peer Specialist | 291 E Swanson Ave, Wasilla, AK 99654-7004 | 2020-10-16 |
| 1003420183 | Brittany Lynne Russell | Peer Specialist | 591 S Knik Goose Bay Rd, Wasilla, AK 99654-8062 | 2020-09-04 |
| 1124632419 | Sydney Grisham | Peer Specialist | 7010 E Bogard Rd, Wasilla, AK 99654-4711 | 2020-09-03 |
| Find all providers in WASILLA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.