Healthcare Provider Details

I. General information

NPI: 1336531359
Provider Name (Legal Business Name): KATY SKARLATOS CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2015
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N 108TH PL STE 100
WAUWATOSA WI
53226-4253
US

IV. Provider business mailing address

530 N 108TH PL STE 100
WAUWATOSA WI
53226-4253
US

V. Phone/Fax

Practice location:
  • Phone: 414-617-3177
  • Fax: 414-375-2048
Mailing address:
  • Phone: 414-617-3177
  • Fax: 414-375-2048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number161-49
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: