Provider Demographics
NPI:1255578910
Name:SKIDMORE, CAROLINE LISA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:LISA
Last Name:SKIDMORE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2570 NW SACAGAWEA LN
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-5529
Mailing Address - Country:US
Mailing Address - Phone:541-317-9822
Mailing Address - Fax:
Practice Address - Street 1:2570 NW SACAGAWEA LN
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-5529
Practice Address - Country:US
Practice Address - Phone:541-317-9822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11950235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist