Provider Demographics
NPI:1093497455
Name:MARTIN, SKYLER (MSW, LMSW, CRADC)
Entity Type:Individual
Prefix:
First Name:SKYLER
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MSW, LMSW, CRADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9233 SOUTHVIEW LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-6441
Mailing Address - Country:US
Mailing Address - Phone:573-578-5709
Mailing Address - Fax:
Practice Address - Street 1:301 SOVEREIGN CT STE 115
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-4435
Practice Address - Country:US
Practice Address - Phone:636-234-3052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023029189104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker