Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 2843 | CO |
N | 103G00000X | Clinical Psychologist | 2843 | CO |
N | 103TC0700X | Clinical Psychologist | 2843 | CO |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 2843 | CO |
N | 103TM1800X | Intellectual & Developmental Disabilities | 2843 | CO |
NPI | 1043248313 |
---|---|
Provider Name | Aaron Emil Skalicky |
First Address | Fort Collins, CO 80525-3210 |
Second Address | Fort Collins, CO 80525-3210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 23/02/2010 |