Individual
MS. JANADELL SKIDMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW, ICADC
Contact information
Practice address
3456 E 17TH ST, SUITE 190, AMMON, ID 83406-6757
(208) 552-9174
(208) 552-9175
Mailing address
452 D ST, IDAHO FALLS, ID 83402-3531
(208) 552-9174
(208) 552-9175
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1160007
ID
104100000X
Social Worker
Primary
LCSW-37255
ID
104100000X
Social Worker
LMSW-27972
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1160007
CADC
ID
01
—
LMSW-27972
LMSW
ID
Enumeration date
07/20/2007
Last updated
06/10/2019
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