Shauncie Marie Skidmore, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301015425 Issued in MI

Practice address

77 Wainwright Dr
Walla Walla, WA 99362-3975

Phone

(509) 525-5200

NPI assigned

May 15, 2007

Last updated

Aug 15, 2013By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376524800000",
    "number": "1720294143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1706 FAIRWAY DR APT 405",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993623707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 WAINWRIGHT DR",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993623975",
            "telephone_number": "509-525-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKIDMORE",
        "first_name": "SHAUNCIE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-15",
        "last_updated": "2013-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301015425",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "KS",
            "license": "LP2108",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Candy Sinden, RN
• Dana T Sineath, FNP-C
• Siskiwit Bay Counseling, PLLC (Tricia Schulte)
• John G Sislow, M.D.
• Gunnar Leighton James Sjoren, DPT
• Emily Anne Skoblar Rea, PSY.D.
• Chloe Slotten, BCBA
• Paige Small, RN
• Patrick R Smart, ARNP
• Herbert L Smeed, P.A.

• Clinical Psychologist in Walla Walla, WA
• Providers in Walla Walla, WA by specialty
• Clinical Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.