Provider Demographics
NPI:1245875269
Name:SKELTON, MAURA LARUE (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:LARUE
Last Name:SKELTON
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 1:345 W 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2754
Mailing Address - Country:US
Mailing Address - Phone:570-660-7769
Mailing Address - Fax:
Practice Address - Street 1:345 W 28TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-2754
Practice Address - Country:US
Practice Address - Phone:570-660-7769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15629235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist