Provider Demographics
NPI:1316579485
Name:PENKO, ERICA (RBT)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:
Last Name:PENKO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 CLEAR SKY CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5951
Mailing Address - Country:US
Mailing Address - Phone:931-682-6195
Mailing Address - Fax:
Practice Address - Street 1:291 CLEAR SKY CT
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5951
Practice Address - Country:US
Practice Address - Phone:931-682-6195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician