Healthcare Provider Details

I. General information

NPI: 1467574798
Provider Name (Legal Business Name): CHERYL ANN SKONICZIN MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 MANOR AVE
DOWNINGTOWN PA
19335-2545
US

IV. Provider business mailing address

100 CHESTNUT TREE RD
ELVERSON PA
19520-9105
US

V. Phone/Fax

Practice location:
  • Phone: 484-698-6126
  • Fax:
Mailing address:
  • Phone: 610-283-4120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL007348
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: