Provider Demographics
NPI:1063641843
Name:SKIBINSKI, TRACY KATHRYN (MS, CCC/SLP)
Entity type:Individual
Prefix:MISS
First Name:TRACY
Middle Name:KATHRYN
Last Name:SKIBINSKI
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 CALLAWAY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:MO
Mailing Address - Zip Code:63341-1628
Mailing Address - Country:US
Mailing Address - Phone:314-482-5000
Mailing Address - Fax:
Practice Address - Street 1:520 WESTWOODS RD
Practice Address - Street 2:
Practice Address - City:WRIGHT CITY
Practice Address - State:MO
Practice Address - Zip Code:63390-3313
Practice Address - Country:US
Practice Address - Phone:636-745-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003008021235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist