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General NPI Number Information
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NPI Number | 1811258395
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Entity Type | Individual
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Provider Name | STEPHEN WILLIAM SKUNDRICH III MS CCC-SLP
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Gender | Male
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Dates
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Enumeration Date | 05/31/2012
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 756 PURVIS DR
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City | WOOD RIVER
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State | IL
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Zip | 62095-1636
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Country | US
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Telephone | 618-570-8192
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Fax |
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Provider Business Mailing Address
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Address Line | 756 PURVIS DR
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City | WOOD RIVER
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State | IL
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Zip | 62095-1636
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Country | US
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Telephone | 618-570-8192
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146.005630
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 117632
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License Number State | MO
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