Provider Demographics
NPI:1942785001
Name:DRISKELL-SKYLES, LOGANN NICOLE
Entity Type:Individual
Prefix:MS
First Name:LOGANN
Middle Name:NICOLE
Last Name:DRISKELL-SKYLES
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 1:817 S LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65711-2124
Mailing Address - Country:US
Mailing Address - Phone:417-259-1991
Mailing Address - Fax:
Practice Address - Street 1:1136 ALLEN ST
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-4004
Practice Address - Country:US
Practice Address - Phone:417-256-6150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist