Healthcare Provider Details

I. General information

NPI: 1174916696
Provider Name (Legal Business Name): VICKIE SKAGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2015
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E TERRA LN
O FALLON MO
63366-2725
US

IV. Provider business mailing address

555 E TERRA LN
O FALLON MO
63366-2725
US

V. Phone/Fax

Practice location:
  • Phone: 636-240-2072
  • Fax: 636-980-1946
Mailing address:
  • Phone: 636-240-2072
  • Fax: 636-980-1946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: