Provider Demographics
NPI:1295982965
Name:SKIDMORE, PATRICIA EILEEN (AUD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:EILEEN
Last Name:SKIDMORE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8371 YANKEE ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-1810
Mailing Address - Country:US
Mailing Address - Phone:937-312-9368
Mailing Address - Fax:937-312-9369
Practice Address - Street 1:8371 YANKEE ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-1810
Practice Address - Country:US
Practice Address - Phone:937-312-9368
Practice Address - Fax:937-312-9369
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.01302231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4116783Medicare PIN
OH4116782Medicare PIN
OH4116784Medicare PIN