1497829071 NPI number — MRS. DEBRA KAY SKYRMS NCC LPC

Table of content: MRS. DEBRA KAY SKYRMS NCC LPC (NPI 1497829071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497829071 NPI number — MRS. DEBRA KAY SKYRMS NCC LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SKYRMS
Provider First Name:
DEBRA
Provider Middle Name:
KAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NCC LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YOUNG
Provider Other First Name:
DEBRA
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497829071
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
E2391 CARDINAL CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAUPACA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54981-9199
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-258-2529
Provider Business Mailing Address Fax Number:
715-258-2529

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
902 RIVERSIDE DR
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
WAUPACA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54981-1992
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-256-1475
Provider Business Practice Location Address Fax Number:
715-256-0705
Provider Enumeration Date:
11/17/2006

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: 101YP2500X , with the licence number:  2903125 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 40979700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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