Basic Information
Provider Information | |||||||||
NPI: | 1710094370 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HOWARD | ||||||||
FirstName: | SKYE-ANN | ||||||||
MiddleName: | K | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HOWARD | ||||||||
OtherFirstName: | ANN | ||||||||
OtherMiddleName: | KATHRYN | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 965 TUCKER RD | ||||||||
Address2: |   | ||||||||
City: | HOOD RIVER | ||||||||
State: | OR | ||||||||
PostalCode: | 970319591 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5414360388 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 965 TUCKER RD | ||||||||
Address2: |   | ||||||||
City: | HOOD RIVER | ||||||||
State: | OR | ||||||||
PostalCode: | 970319591 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5413866665 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/23/2006 | ||||||||
LastUpdateDate: | 06/07/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 4914 | KS | N |   | Behavioral Health & Social Service Providers | Social Worker |   | 133N00000X | 000996 | CO | N |   | Dietary & Nutritional Service Providers | Nutritionist |   | 101Y00000X |   | OR | Y |   | Behavioral Health & Social Service Providers | Counselor |   |
No ID Information.