Provider Demographics
NPI:1386343531
Name:SKINNER, REILLY (PSS)
Entity type:Individual
Prefix:
First Name:REILLY
Middle Name:
Last Name:SKINNER
Suffix:
Gender:M
Credentials:PSS
Other - Prefix:
Other - First Name:EZRA
Other - Middle Name:
Other - Last Name:LAMBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3886 BEVERLY AVE NE STE 6
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1373
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3886 BEVERLY AVE NE STE 6
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1373
Practice Address - Country:US
Practice Address - Phone:541-342-5088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist