Basic Information
| Provider Information | |||||||||
| NPI: | 1396815049 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SKIDMORE | ||||||||
| FirstName: | RICK | ||||||||
| MiddleName: | WADE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | L.I.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4651 N SUMMIT ST | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436112814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194075100 | ||||||||
| FaxNumber: | 4198850203 | ||||||||
| Practice Location | |||||||||
| Address1: | 4651 N SUMMIT ST | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436112814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194075100 | ||||||||
| FaxNumber: | 4198850203 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 02/27/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | I - 0008486 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.