Provider Demographics
NPI:1821411414
Name:SKOWRON, SARA (EDS)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:SKOWRON
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:STRUTHERS
Mailing Address - State:OH
Mailing Address - Zip Code:44471-1831
Mailing Address - Country:US
Mailing Address - Phone:330-755-3354
Mailing Address - Fax:
Practice Address - Street 1:99 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:STRUTHERS
Practice Address - State:OH
Practice Address - Zip Code:44471-1831
Practice Address - Country:US
Practice Address - Phone:330-755-3354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20797304103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool