Provider Demographics
NPI:1285642165
Name:SKAGGS, CHRISTOPHER P (SPEECH LANGUAGE PATH)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:P
Last Name:SKAGGS
Suffix:
Gender:M
Credentials:SPEECH LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 396
Mailing Address - Street 2:5409 EVERYBODYS ROAD FOREST COUNTY POTAWATOMI HEALTH &
Mailing Address - City:CRANDON
Mailing Address - State:WI
Mailing Address - Zip Code:54520
Mailing Address - Country:US
Mailing Address - Phone:715-478-4300
Mailing Address - Fax:715-478-4490
Practice Address - Street 1:5409 EVERYBODYS ROAD
Practice Address - Street 2:FOREST COUNTY POTAWATOMI HEALTH & WELLNESS CENTER
Practice Address - City:CRANDON
Practice Address - State:WI
Practice Address - Zip Code:54520
Practice Address - Country:US
Practice Address - Phone:715-478-4300
Practice Address - Fax:715-478-4490
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2064154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42783500Medicaid
WI66476OtherSECURITY HEALTH PLAN