Provider Demographics
NPI:1518724210
Name:SKIDMORE, MEGHAN MICHELLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:MICHELLE
Last Name:SKIDMORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 WINGATE PL
Mailing Address - Street 2:
Mailing Address - City:ROCKTON
Mailing Address - State:IL
Mailing Address - Zip Code:61072-3420
Mailing Address - Country:US
Mailing Address - Phone:815-519-5963
Mailing Address - Fax:
Practice Address - Street 1:612 WINGATE PL
Practice Address - Street 2:
Practice Address - City:ROCKTON
Practice Address - State:IL
Practice Address - Zip Code:61072-3420
Practice Address - Country:US
Practice Address - Phone:815-519-5963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0113821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical