Provider Demographics
NPI:1306713672
Name:WILLETT, PENNY LOU (LCSW)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:LOU
Last Name:WILLETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 E PIKE ST
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-1700
Mailing Address - Country:US
Mailing Address - Phone:859-588-2541
Mailing Address - Fax:
Practice Address - Street 1:523 E PIKE ST
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-1700
Practice Address - Country:US
Practice Address - Phone:859-588-2541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-21
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLCSW000011201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty