Basic Information
| Provider Information | |||||||||
| NPI: | 1598338329 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SKIPWORTH | ||||||||
| FirstName: | KATHERINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3494 LIBERTY RD S | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973024607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9713040660 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1775 PARK DR | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973554000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413688448 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2021 | ||||||||
| LastUpdateDate: | 07/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.