Provider Demographics
NPI:1306018114
Name:PENDLETON, MARCY JOANN (SLP)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:JOANN
Last Name:PENDLETON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6035
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-6000
Mailing Address - Country:US
Mailing Address - Phone:704-868-8551
Mailing Address - Fax:704-868-8552
Practice Address - Street 1:1010 E GARRISON BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4521
Practice Address - Country:US
Practice Address - Phone:704-868-8551
Practice Address - Fax:704-868-8552
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008639235Z00000X
NC8076235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist