Jordan Skalisky, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY61337933 Issued in WA

Practice address

711 State Ave NE
Olympia, WA 98506-3984

Phone

(360) 943-0780

Fax

(360) 943-0785

NPI assigned

Aug 26, 2019

Sex

Female

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 Apr 25, 2025 through Apr 25, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1566777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775088000000",
    "number": "1497302210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5010 KENRICK ST SE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985037303",
            "telephone_number": "206-678-9895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 STATE AVE NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985063984",
            "telephone_number": "360-943-0780",
            "fax_number": "360-943-0785"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5010 Kenrick St SE",
            "address_purpose": "LOCATION",
            "city": "Lacey",
            "state": "WA",
            "postal_code": "985037303",
            "country_code": "US",
            "telephone_number": "206-312-1803",
            "fax_number": "206-488-1544",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SKALISKY",
        "first_name": "JORDAN",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-26",
        "last_updated": "2026-04-02",
        "certification_date": "2026-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WA",
            "license": "PY61337933",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Olympia, WA
• Providers in Olympia, WA by specialty
• Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2026; 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.