Healthcare Provider Details

I. General information

NPI: 1063641843
Provider Name (Legal Business Name): TRACY KATHRYN SKIBINSKI M.S., CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 WESTWOODS RD
WRIGHT CITY MO
63390-3313
US

IV. Provider business mailing address

410 CALLAWAY RIDGE DR
DEFIANCE MO
63341-1628
US

V. Phone/Fax

Practice location:
  • Phone: 636-745-7300
  • Fax:
Mailing address:
  • Phone: 314-482-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2003008021
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: