Basic Information
| Provider Information | |||||||||
| NPI: | 1508961012 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SKELLY | ||||||||
| FirstName: | JANET | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | HIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8800 SE SUNNYSIDE RD | ||||||||
| Address2: | SUITE 300-N | ||||||||
| City: | CLACKAMAS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970155738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036595115 | ||||||||
| FaxNumber: | 5036595968 | ||||||||
| Practice Location | |||||||||
| Address1: | 5124 HOLLYWOOD BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549876577 | ||||||||
| FaxNumber: | 9549876195 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 01/18/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | AS1826 | FL | N | Other Service Providers | Specialist | 237700000X | AS1826 | FL | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.