Provider Demographics
NPI:1174908461
Name:PENNEY, REBECCA L (BC-HIS)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:PENNEY
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-1747
Mailing Address - Country:US
Mailing Address - Phone:478-746-8462
Mailing Address - Fax:478-254-7806
Practice Address - Street 1:2116 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-1747
Practice Address - Country:US
Practice Address - Phone:478-746-8462
Practice Address - Fax:478-254-7806
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA464237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist