Provider Demographics
NPI:1326538786
Name:SKINNER, LAUREN DANIELLE
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:DANIELLE
Last Name:SKINNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:IL
Mailing Address - Zip Code:61914-8402
Mailing Address - Country:US
Mailing Address - Phone:217-665-3541
Mailing Address - Fax:
Practice Address - Street 1:319 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:IL
Practice Address - Zip Code:61914-8402
Practice Address - Country:US
Practice Address - Phone:217-665-3541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist