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NPI Code Detail

MEDICARE: DANA RENEE SKIDMORE BSW

MEDICARE: DANA RENEE SKIDMORE BSW
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker6802081702MI

General Provider Information

NPI Number : 1841314903
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANA RENEE SKIDMORE BSW
Provider Business Mailing Address
First Line : 1485 M 139
Second Line :
City : BENTON HARBOR
State : MI
Zip : 49022-5711
Country : US
Telephone Number : 269-925-0585
Fax Number : 269-927-1326
Provider Business Practice Location Address
First Line : 1485 M 139
Second Line :
City : BENTON HARBOR
State : MI
Zip : 49022-5711
Country : US
Telephone Number : 269-925-0585
Fax Number : 269-927-1326
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2007
Last Update Date : 07/08/2007

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Directions to “ DANA RENEE SKIDMORE BSW” Practice Location

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