Provider Demographics
NPI:1609544501
Name:SKILES, JOANNA GRACE (MS)
Entity type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:GRACE
Last Name:SKILES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:GRACE
Other - Last Name:AUGUSTINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:127 ASHLEY CIR APT 2
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-2890
Mailing Address - Country:US
Mailing Address - Phone:904-962-1749
Mailing Address - Fax:
Practice Address - Street 1:2470 DANIELLS BRIDGE RD STE 300
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6192
Practice Address - Country:US
Practice Address - Phone:706-389-2950
Practice Address - Fax:706-389-2951
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP012221235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist