Jon Bullock Skidmore, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

266381-2501 Issued in UT

Practice address

363 E 1200 S
Orem, UT 84058-6904

Phone

(801) 426-2685

NPI assigned

Apr 2, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 1, 2018 through Oct 1, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Utah Valley Psychology Counseling and Coaching

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Orem, UT
  • NPI 1497462840
  NPD (past)
• St Health TX, P.a.

  • Clinical Psychologist
  • New York, NY
  • NPI 1982476685
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407977903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 336",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840590336",
            "telephone_number": "801-426-2685",
            "fax_number": "801-224-4475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "363 E 1200 S",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840586904",
            "telephone_number": "801-426-2685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKIDMORE",
        "first_name": "JON",
        "middle_name": "BULLOCK",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "UT",
            "license": "266381-2501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Rose Sincock
• Abigail Sinema
• Allison Nicole Sipple, PA-C
• Berkeley Sirmans
• Faith Skidmore
• Madyson Leigh Slagle
• David Slater
• Heather Ann Slater, AS, RBT
• Jack Ryan Slater
• Jennifer Slauson, LCSW

• Clinical Psychologist in Orem, UT
• Providers in Orem, UT by specialty
• Clinical Psychologist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.