Individual
NICOLE R SKODACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CTRS
Contact information
Practice address
1719 WISCONSIN AVE, GRAND HAVEN, MI 49417-2576
(616) 540-4911
Mailing address
1719 WISCONSIN AVE, GRAND HAVEN, MI 49417-2576
(616) 540-4911
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
—
—
Other
Enumeration date
08/23/2016
Last updated
08/23/2016
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