Provider Demographics
NPI:1063498277
Name:SKOLODA, NICOLE (MA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SKOLODA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:OURAY
Mailing Address - State:CO
Mailing Address - Zip Code:81427-0105
Mailing Address - Country:US
Mailing Address - Phone:970-318-8860
Mailing Address - Fax:
Practice Address - Street 1:812 MAIN STREET
Practice Address - Street 2:
Practice Address - City:OURAY
Practice Address - State:CO
Practice Address - Zip Code:81427
Practice Address - Country:US
Practice Address - Phone:970-318-8860
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0119991235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist