Provider Demographics
NPI:1427796739
Name:SKELTON, SAMUEL H (MS)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:H
Last Name:SKELTON
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1298 E 1640 S
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-6267
Mailing Address - Country:US
Mailing Address - Phone:479-595-1830
Mailing Address - Fax:
Practice Address - Street 1:3293 HARRISON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-5503
Practice Address - Country:US
Practice Address - Phone:479-595-1830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13523746-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist