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General NPI Number Information
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NPI Number | 1134886955
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Entity Type | Individual
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Provider Name | THERESA SKOTLESKI
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Gender | Female
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Dates
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Enumeration Date | 11/29/2021
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Last Update Date | 07/06/2023
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Provider Practice Location Address
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Address Line | 1031 MAIN ST
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City | PECKVILLE
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State | PA
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Zip | 18452-2103
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Country | US
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Telephone | 570-307-9023
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Fax |
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Provider Business Mailing Address
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Address Line | 121 S TURNPIKE RD
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City | DALTON
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State | PA
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Zip | 18414-9508
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Country | US
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Telephone | 570-878-7586
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW129466
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License Number State | PA
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