MEDICARE: KATHLEEN SKILTON PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0810001277	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000139	OTHER	VA	VALUOPTIONS PROVIDER ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	5512003	OTHER	VA	AETNA PROVIDER ID

General Provider Information

NPI Number	:	1922026194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN SKILTON PH.D.

Provider Business Mailing Address
First Line	:	3921 OLD LEE HWY
Second Line	:	73-A
City	:	FAIRFAX
State	:	VA
Zip	:	22030-2429
Country	:	US
Telephone Number	:	703-591-8668
Fax Number	:	703-691-8496

Provider Business Practice Location Address
First Line	:	3921 OLD LEE HWY
Second Line	:	73-A
City	:	FAIRFAX
State	:	VA
Zip	:	22030-2429
Country	:	US
Telephone Number	:	703-591-8668
Fax Number	:	703-691-8496

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/08/2007

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Directions to “ KATHLEEN SKILTON PH.D.” Practice Location

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