Provider Demographics
NPI:1871366815
Name:SKALETSKY, HARRY
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:
Last Name:SKALETSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9970 CODDINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-2904
Mailing Address - Country:US
Mailing Address - Phone:847-772-8045
Mailing Address - Fax:
Practice Address - Street 1:140 CLIFF CAVE RD STE 200
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-3646
Practice Address - Country:US
Practice Address - Phone:314-683-9105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210478171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical