Healthcare Provider Details

I. General information

NPI: 1801260963
Provider Name (Legal Business Name): JONATHAN SKIDMORE MSW, LISW-S, CTP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2015
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6715 DORR ST.
TOLEDO OH
43615
US

IV. Provider business mailing address

PO BOX 400
HOLLAND OH
43528
US

V. Phone/Fax

Practice location:
  • Phone: 419-868-1178
  • Fax: 419-868-1989
Mailing address:
  • Phone: 419-841-7701
  • Fax: 419-841-1691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1502371
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: