Provider Demographics
NPI:1285049049
Name:SKAINS, SUE WONA
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:WONA
Last Name:SKAINS
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 1:4396 HIGHWAY 80
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-8948
Mailing Address - Country:US
Mailing Address - Phone:318-251-4659
Mailing Address - Fax:318-251-4659
Practice Address - Street 1:4396 HIGHWAY 80
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-8948
Practice Address - Country:US
Practice Address - Phone:318-251-4659
Practice Address - Fax:318-251-4659
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA81651041C0700X, 104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA13579Medicaid