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NPI Code Detail

MEDICARE: KELLY ELIZABETH SKORE BA, CDP

MEDICARE: KELLY ELIZABETH SKORE BA, CDP
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCP60859062WA

General Provider Information

NPI Number : 1922582535
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY ELIZABETH SKORE BA, CDP
Provider Business Mailing Address
First Line : 12850 LALA COVE LN SE
Second Line :
City : OLALLA
State : WA
Zip : 98359-9664
Country : US
Telephone Number : 253-857-6201
Fax Number : 253-857-3993
Provider Business Practice Location Address
First Line : 12850 LALA COVE LN SE
Second Line :
City : OLALLA
State : WA
Zip : 98359-9664
Country : US
Telephone Number : 253-857-6201
Fax Number : 253-857-3993
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2018
Last Update Date : 09/19/2018

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