Provider Demographics
NPI:1942547906
Name:SKIDMORE, ROBERT C (MDIV, MA, LPC, CADC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:C
Last Name:SKIDMORE
Suffix:
Gender:M
Credentials:MDIV, MA, LPC, CADC
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:ISAAC
Other - Last Name:SKIDMORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MDIV, MA, LPC, CADC
Mailing Address - Street 1:18 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7309
Mailing Address - Country:US
Mailing Address - Phone:541-857-0873
Mailing Address - Fax:541-245-1530
Practice Address - Street 1:18 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7309
Practice Address - Country:US
Practice Address - Phone:541-857-0873
Practice Address - Fax:541-245-1530
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3047101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional