Provider Demographics
NPI:1083997548
Name:CHUBAK, SKYLER JOHN I
Entity Type:Individual
Prefix:PROF
First Name:SKYLER
Middle Name:JOHN
Last Name:CHUBAK
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 S WEST TEMPLE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-3120
Mailing Address - Country:US
Mailing Address - Phone:801-413-9820
Mailing Address - Fax:
Practice Address - Street 1:780 SOUTH GAURDSMEN WAY
Practice Address - Street 2:
Practice Address - City:SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-883-5325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health