Healthcare Provider Details

I. General information

NPI: 1194152587
Provider Name (Legal Business Name): MICHELE SCHMIDT SKOLNICKI MA, PHD, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 NOBLE DR
WOOSTER OH
44691-5353
US

IV. Provider business mailing address

203 EVERGREEN DR
CRESTON OH
44217-9486
US

V. Phone/Fax

Practice location:
  • Phone: 330-202-3862
  • Fax:
Mailing address:
  • Phone: 330-418-5793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS-0022560
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2001871
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: