Provider Demographics
NPI:1750501003
Name:SKINNER, JANICE KAY (MA SLP CCC)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:KAY
Last Name:SKINNER
Suffix:
Gender:F
Credentials:MA SLP CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W PATTON ST
Mailing Address - Street 2:
Mailing Address - City:STURGEON
Mailing Address - State:MO
Mailing Address - Zip Code:65284-9564
Mailing Address - Country:US
Mailing Address - Phone:573-687-3515
Mailing Address - Fax:573-687-2116
Practice Address - Street 1:STURGEON R-V SCHOOL
Practice Address - Street 2:210 W PATTON ST
Practice Address - City:STURGEON
Practice Address - State:MO
Practice Address - Zip Code:65284-9564
Practice Address - Country:US
Practice Address - Phone:573-687-3515
Practice Address - Fax:573-687-2116
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01348235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO467507208Medicaid