Healthcare Provider Details

I. General information

NPI: 1891601605
Provider Name (Legal Business Name): MS. SKYLAR MACKENZIE DIGOU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1332 PLANTATION RD NE
ROANOKE VA
24012-5713
US

IV. Provider business mailing address

815 MOREHEAD AVE SE
ROANOKE VA
24013-2735
US

V. Phone/Fax

Practice location:
  • Phone: 410-910-1607
  • Fax:
Mailing address:
  • Phone: 678-977-3607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: