Provider Demographics
NPI:1548786643
Name:PAHL, SKYE MICHAEL
Entity Type:Individual
Prefix:
First Name:SKYE
Middle Name:MICHAEL
Last Name:PAHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 KOCH DR APT 311
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-1246
Mailing Address - Country:US
Mailing Address - Phone:605-877-2552
Mailing Address - Fax:
Practice Address - Street 1:1500 E CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-2001
Practice Address - Country:US
Practice Address - Phone:701-204-7870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRBT-17-36642106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician