Provider Demographics
NPI:1407511520
Name:SKIDMORE, MITCHELL ALEXANDER (LSCSW)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:ALEXANDER
Last Name:SKIDMORE
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3649 SW BURLINGAME RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66611-2155
Mailing Address - Country:US
Mailing Address - Phone:785-205-6588
Mailing Address - Fax:785-266-4533
Practice Address - Street 1:3649 SW BURLINGAME RD STE 100
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611-2155
Practice Address - Country:US
Practice Address - Phone:785-205-6588
Practice Address - Fax:785-266-4533
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS061001041C0700X
KS11421104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker