Provider Demographics
NPI:1255664785
Name:SKINNER, DARREL (MSW)
Entity type:Individual
Prefix:
First Name:DARREL
Middle Name:
Last Name:SKINNER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 1ST WEST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:WY
Mailing Address - Zip Code:83112
Mailing Address - Country:US
Mailing Address - Phone:307-885-1577
Mailing Address - Fax:
Practice Address - Street 1:217 1ST WEST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:WY
Practice Address - Zip Code:83112
Practice Address - Country:US
Practice Address - Phone:307-885-1577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator