Provider Demographics
NPI:1235874793
Name:PENNYMAN, NATALIE (MSW,LISW-S)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:PENNYMAN
Suffix:
Gender:F
Credentials:MSW,LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 HOLLYBRIER DR APT 319
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-8475
Mailing Address - Country:US
Mailing Address - Phone:614-632-4834
Mailing Address - Fax:
Practice Address - Street 1:70 BIRCH ALY STE 240
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45440-1477
Practice Address - Country:US
Practice Address - Phone:866-975-7469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1600112104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker