Provider Demographics
NPI:1750693107
Name:SKINNER, ELIZABETH R (CCC/SLP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R
Last Name:SKINNER
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 149TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-2550
Mailing Address - Country:US
Mailing Address - Phone:718-224-3947
Mailing Address - Fax:718-224-3953
Practice Address - Street 1:1529 149TH ST
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-2550
Practice Address - Country:US
Practice Address - Phone:718-224-3947
Practice Address - Fax:718-224-3953
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011281-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist