Healthcare Provider Details

I. General information

NPI: 1285049049
Provider Name (Legal Business Name): SUE WONA SKAINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4396 HIGHWAY 80
RUSTON LA
71270-8948
US

IV. Provider business mailing address

4396 HIGHWAY 80
RUSTON LA
71270-8948
US

V. Phone/Fax

Practice location:
  • Phone: 318-251-4659
  • Fax: 318-251-4659
Mailing address:
  • Phone: 318-251-4659
  • Fax: 318-251-4659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number8165
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8165
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: