Provider Demographics
NPI:1093529224
Name:SKILLERN, AVERIE ALEXANDRA
Entity type:Individual
Prefix:
First Name:AVERIE
Middle Name:ALEXANDRA
Last Name:SKILLERN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 DUQUETTE LN
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-5910
Mailing Address - Country:US
Mailing Address - Phone:618-604-9393
Mailing Address - Fax:
Practice Address - Street 1:205 DUQUETTE LN
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-5910
Practice Address - Country:US
Practice Address - Phone:618-604-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022028801101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional