Provider Demographics
NPI:1093974123
Name:PENNINGTON, CARLA M (MED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:M
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 LONG NEEDLE CIR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-5170
Mailing Address - Country:US
Mailing Address - Phone:706-829-4848
Mailing Address - Fax:
Practice Address - Street 1:434 LONG NEEDLE CIR
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-5170
Practice Address - Country:US
Practice Address - Phone:706-829-4848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3424235Z00000X
GASLP005317235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist