Provider Demographics
NPI:1922208966
Name:SKEENS, CHARLENE NICOLE (SLP)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:NICOLE
Last Name:SKEENS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1876 LITTLE HARDWICKS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CLAY CITY
Mailing Address - State:KY
Mailing Address - Zip Code:40312-9040
Mailing Address - Country:US
Mailing Address - Phone:606-663-6777
Mailing Address - Fax:
Practice Address - Street 1:31 DERICKSON LN
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:KY
Practice Address - Zip Code:40380-2153
Practice Address - Country:US
Practice Address - Phone:606-663-0435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY07-033235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist