Provider Demographics
NPI:1366569212
Name:SKIDMORE, SUZETTE (CMT)
Entity type:Individual
Prefix:MRS
First Name:SUZETTE
Middle Name:
Last Name:SKIDMORE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6363 W 120TH AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-2406
Mailing Address - Country:US
Mailing Address - Phone:720-768-3381
Mailing Address - Fax:
Practice Address - Street 1:6363 W 120TH AVE STE 310
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-2406
Practice Address - Country:US
Practice Address - Phone:720-768-3381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist