Provider Demographics
NPI:1780745893
Name:SKOWRON, JARED M (ND)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:M
Last Name:SKOWRON
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:857 N MAIN STREET EXT
Mailing Address - Street 2:#2
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2465
Mailing Address - Country:US
Mailing Address - Phone:203-265-0444
Mailing Address - Fax:203-265-0472
Practice Address - Street 1:857 N MAIN STREET EXT
Practice Address - Street 2:#2
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2465
Practice Address - Country:US
Practice Address - Phone:203-265-0444
Practice Address - Fax:203-265-0472
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT000357175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010357OtherCONNECTICARE
CT110000357CT01OtherBLUE CROSS ANTHEM