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General NPI Number Information
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NPI Number | 1104181395
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Entity Type | Individual
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Provider Name | BREANNE NICKOLE SKIDMORE LSW
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Gender | Female
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Dates
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Enumeration Date | 07/12/2012
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Last Update Date | 07/12/2012
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Provider Practice Location Address
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Address Line | 1490 E MAIN ST
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City | COLUMBUS
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State | OH
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Zip | 43205-2140
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Country | US
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Telephone | 614-252-0731
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Fax |
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Provider Business Mailing Address
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Address Line | 1511 RUNAWAY BAY DR APT. 1B
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City | COLUMBUS
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State | OH
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Zip | 43204-4811
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Country | US
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Telephone | 440-313-5029
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | S 1100875
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License Number State | OH
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