Healthcare Provider Details

I. General information

NPI: 1972214948
Provider Name (Legal Business Name): SKYLER MARIE PINK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 WHITEBUSH WAY
ASTORIA OR
97103-5752
US

IV. Provider business mailing address

55 WHITEBUSH WAY
ASTORIA OR
97103-5752
US

V. Phone/Fax

Practice location:
  • Phone: 586-817-0076
  • Fax:
Mailing address:
  • Phone: 586-817-0076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberR9512
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: