Provider Demographics
NPI:1114100716
Name:MANNING, PENNY S (LCPC)
Entity Type:Individual
Prefix:MS
First Name:PENNY
Middle Name:S
Last Name:MANNING
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3S331 WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-2742
Mailing Address - Country:US
Mailing Address - Phone:630-399-0440
Mailing Address - Fax:630-393-1979
Practice Address - Street 1:3S331 WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-2742
Practice Address - Country:US
Practice Address - Phone:630-399-0440
Practice Address - Fax:630-393-1979
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2227847101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional