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General NPI Number Information
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NPI Number | 1497302210
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Entity Type | Individual
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Provider Name | JORDAN SKALISKY PHD
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Gender | Female
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Dates
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Enumeration Date | 08/26/2019
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 1005 OLYMPIA AVE NE
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City | OLYMPIA
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State | WA
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Zip | 98506-4033
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Country | US
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Telephone | 206-312-1803
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Fax | 206-488-1544
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Provider Business Mailing Address
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Address Line | 5010 KENRICK ST SE
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City | LACEY
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State | WA
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Zip | 98503-7303
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Country | US
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Telephone | 206-678-9895
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY61337933
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License Number State | WA
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