MEDICARE: LAQUANDRA M SKINNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst		NV

General Provider Information

NPI Number	:	1710324702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAQUANDRA M SKINNER

Provider Business Mailing Address
First Line	:	3885 S DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-5855
Country	:	US
Telephone Number	:	702-643-5888
Fax Number	:

Provider Business Practice Location Address
First Line	:	3885 S DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-5855
Country	:	US
Telephone Number	:	702-643-5888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2013
Last Update Date	:	05/30/2013

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Directions to “ LAQUANDRA M SKINNER ” Practice Location

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