Provider Demographics
NPI:1922298843
Name:SKILLICORN, JODIE LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:JODIE
Middle Name:LYNN
Last Name:SKILLICORN
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:3610 WEST MARKET STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-9301
Mailing Address - Country:US
Mailing Address - Phone:330-715-9282
Mailing Address - Fax:330-752-2541
Practice Address - Street 1:3610 WEST MARKET STREET
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-9301
Practice Address - Country:US
Practice Address - Phone:330-715-9282
Practice Address - Fax:330-752-2541
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH340089242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry