Provider Demographics
NPI:1710722806
Name:IHNE GAZELEY, SKYLA KENZIE
Entity type:Individual
Prefix:
First Name:SKYLA
Middle Name:KENZIE
Last Name:IHNE GAZELEY
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 1:1361 QUINCY ST APT 15E
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2210
Mailing Address - Country:US
Mailing Address - Phone:630-881-4462
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1257
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:OR
Practice Address - Zip Code:97535-1257
Practice Address - Country:US
Practice Address - Phone:541-535-4133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health