Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 1194-226 | WI |
N | 101YS0200X | School Counselor | 701197 | WI |
NPI | 1063779700 |
---|---|
Provider Name | Jennifer Skinner |
First Address | West Bend, WI 53095-3394 |
Second Address | West Bend, WI 53095-3394 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2012 |
Last Update Date | 19/04/2012 |