Provider Demographics
NPI:1194188003
Name:PENMAN, TALON
Entity Type:Individual
Prefix:
First Name:TALON
Middle Name:
Last Name:PENMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 25TH ST
Mailing Address - Street 2:APARTMENT 102
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-6820
Mailing Address - Country:US
Mailing Address - Phone:801-644-1749
Mailing Address - Fax:
Practice Address - Street 1:550 25TH ST
Practice Address - Street 2:APARTMENT 102
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-6820
Practice Address - Country:US
Practice Address - Phone:801-644-1749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT260022408OtherRAILROAD MEDICARE
UT876000308007Medicaid
UT000055266Medicare PIN