Basic Information
Provider Information | |||||||||
NPI: | 1942346051 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SKIBICKY | ||||||||
FirstName: | ULIANA | ||||||||
MiddleName: | V | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PHD, RD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | W6920 E SOUTH SHORE DR | ||||||||
Address2: |   | ||||||||
City: | PARDEEVILLE | ||||||||
State: | WI | ||||||||
PostalCode: | 539549463 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6085161280 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2901 HUNTERS TRL | ||||||||
Address2: |   | ||||||||
City: | PORTAGE | ||||||||
State: | WI | ||||||||
PostalCode: | 539013403 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6087425518 | ||||||||
FaxNumber: | 6087424087 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/29/2007 | ||||||||
LastUpdateDate: | 03/07/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | 3013-57 | WI | Y |   | Behavioral Health & Social Service Providers | Psychologist | Counseling |
ID Information
ID | Type | State | Issuer | Description | 41004900 | 01 | WI | MEDICAL ASSISTANCE | OTHER |