Provider Demographics
NPI:1336904119
Name:SKUDLAREK, ANNEMARIE VALLEY (ACMHC)
Entity Type:Individual
Prefix:
First Name:ANNEMARIE
Middle Name:VALLEY
Last Name:SKUDLAREK
Suffix:
Gender:F
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 N MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-5009
Mailing Address - Country:US
Mailing Address - Phone:435-850-7378
Mailing Address - Fax:
Practice Address - Street 1:1244 N MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-5009
Practice Address - Country:US
Practice Address - Phone:435-850-7378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13800855-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health