Provider Demographics
NPI:1134296734
Name:KAYTON, PENNY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:KAYTON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 N CONSTELLATION WAY
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-3900
Mailing Address - Country:US
Mailing Address - Phone:480-231-7026
Mailing Address - Fax:
Practice Address - Street 1:804 N CONSTELLATION WAY
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-3900
Practice Address - Country:US
Practice Address - Phone:480-231-7026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0145235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ543183Medicaid