Provider Demographics
NPI:1295935963
Name:SKIDMORE, JANADELL (LMSW, ICADC)
Entity type:Individual
Prefix:MS
First Name:JANADELL
Middle Name:
Last Name:SKIDMORE
Suffix:
Gender:F
Credentials:LMSW, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 D ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-3531
Mailing Address - Country:US
Mailing Address - Phone:208-552-9174
Mailing Address - Fax:208-552-9175
Practice Address - Street 1:3456 E 17TH ST
Practice Address - Street 2:SUITE 190
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-6757
Practice Address - Country:US
Practice Address - Phone:208-552-9174
Practice Address - Fax:208-552-9175
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1160007101YA0400X
IDLCSW-37255104100000X
IDLMSW-27972104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1160007OtherCADC
IDLMSW-27972OtherLMSW