Provider Demographics
NPI:1982649646
Name:SKINNER, BETTY ROSE (MS/CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:ROSE
Last Name:SKINNER
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2848 LONGLEAF RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-2045
Mailing Address - Country:US
Mailing Address - Phone:850-763-8922
Mailing Address - Fax:
Practice Address - Street 1:2848 LONGLEAF RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-2045
Practice Address - Country:US
Practice Address - Phone:850-763-8922
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA399235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist