Provider Demographics
NPI:1629511605
Name:SKIPPER, JONATHON DANE
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:DANE
Last Name:SKIPPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2918 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32448-2717
Mailing Address - Country:US
Mailing Address - Phone:850-372-4065
Mailing Address - Fax:
Practice Address - Street 1:2918 PENN AVE
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32448-2717
Practice Address - Country:US
Practice Address - Phone:850-372-4065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5234231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist