Provider Demographics
NPI:1881916039
Name:SKIDMORE SPEECH AND LANGUAGE SERVICES
Entity type:Organization
Organization Name:SKIDMORE SPEECH AND LANGUAGE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:SKIDMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:541-633-5288
Mailing Address - Street 1:15 NW PARK PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-2977
Mailing Address - Country:US
Mailing Address - Phone:541-633-5288
Mailing Address - Fax:
Practice Address - Street 1:15 NW PARK PL
Practice Address - Street 2:SUITE 100
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-2977
Practice Address - Country:US
Practice Address - Phone:541-633-5288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11950235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty