Healthcare Provider Details

I. General information

NPI: 1902050768
Provider Name (Legal Business Name): NANCY A SKOPP PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NANCY SKOPP PH.D.

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE
TACOMA WA
98431-0001
US

IV. Provider business mailing address

9040 JACKSON AVE
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-3356
  • Fax:
Mailing address:
  • Phone: 253-968-3356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number33616
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6898948-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: