Provider Demographics
NPI:1033608914
Name:SKIDMORE, ALEXIS RAE (BA PSYCHOLOGY)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:RAE
Last Name:SKIDMORE
Suffix:
Gender:F
Credentials:BA PSYCHOLOGY
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Mailing Address - Street 1:2801 ALEXANDRA DR APT 2913
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-6031
Mailing Address - Country:US
Mailing Address - Phone:707-774-4298
Mailing Address - Fax:
Practice Address - Street 1:2801 ALEXANDRA DR APT 2913
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-6031
Practice Address - Country:US
Practice Address - Phone:707-774-4298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-06
Last Update Date:2018-05-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst