Provider Demographics
NPI:1447811518
Name:SKIDMORE, STEFANIE (BSC, MSC, NLC)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:SKIDMORE
Suffix:
Gender:F
Credentials:BSC, MSC, NLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 STAGECOACH RD
Mailing Address - Street 2:
Mailing Address - City:GUFFEY
Mailing Address - State:CO
Mailing Address - Zip Code:80820-8500
Mailing Address - Country:US
Mailing Address - Phone:719-377-8587
Mailing Address - Fax:
Practice Address - Street 1:13576 COUNTY RD 1
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:CO
Practice Address - Zip Code:80816-9001
Practice Address - Country:US
Practice Address - Phone:719-377-8587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional