MEDICARE: SHERI SKIDMORE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	103K00000X	Behavior Analyst
2	247200000X	Other Technician
3	101Y00000X	Counselor	WA

General Provider Information

NPI Number	:	1417332719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERI SKIDMORE

Provider Business Mailing Address
First Line	:	4575 SE DIXIE HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-6826
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 DEXTER AVE N
Second Line	:	SUITE 100
City	:	SEATTLE
State	:	WA
Zip	:	98109-3598
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2015
Last Update Date	:	02/05/2018

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Directions to “ SHERI SKIDMORE ” Practice Location

Language	Start Address	Practice Location

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