Provider Demographics
NPI:1184799512
Name:SKINNER, JILL M (LIMHP, LCSW)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:M
Last Name:SKINNER
Suffix:
Gender:F
Credentials:LIMHP, LCSW
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:M
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 N BAILEY AVE
Mailing Address - Street 2:P.O. BOX 1209
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-1209
Mailing Address - Country:US
Mailing Address - Phone:308-284-6519
Mailing Address - Fax:308-284-6513
Practice Address - Street 1:401 WEST 1ST
Practice Address - Street 2:
Practice Address - City:OGALLALA
Practice Address - State:NE
Practice Address - Zip Code:69153-2412
Practice Address - Country:US
Practice Address - Phone:308-284-3084
Practice Address - Fax:308-284-6513
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1526101YM0800X
NE9591041C0700X
NE124101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
083031OtherRAILROAD
84155OtherBLUE CROSS
NE47083176426Medicaid