1790880201 NPI number — ADRIENNE A SKINNER PSYD

Table of content: ADRIENNE A SKINNER PSYD (NPI 1790880201)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790880201 NPI number — ADRIENNE A SKINNER PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SKINNER
Provider First Name:
ADRIENNE
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790880201
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 S WEBSTER ST STE 203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60540-4477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-984-6608
Provider Business Mailing Address Fax Number:
630-984-6608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 S WEBSTER ST STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60540-4477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-984-6608
Provider Business Practice Location Address Fax Number:
630-984-6608
Provider Enumeration Date:
09/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  071007049 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)