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NPI Code Detail

MEDICARE: WILLIAM M SKINNER

MEDICARE: WILLIAM 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
1103T00000XPsychologist6301001796MI

General Provider Information

NPI Number : 1952508863
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM M SKINNER
Provider Business Mailing Address
First Line : 1490 E BELTLINE AVE SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49506-4336
Country : US
Telephone Number : 616-940-0040
Fax Number :
Provider Business Practice Location Address
First Line : 1490 E BELTLINE AVE SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49506-4336
Country : US
Telephone Number : 616-940-0040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2007
Last Update Date : 07/08/2007

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Directions to “ WILLIAM M SKINNER ” Practice Location

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