Provider Demographics
NPI:1417179243
Name:BELL, PENNY S (SUDP)
Entity Type:Individual
Prefix:MS
First Name:PENNY
Middle Name:S
Last Name:BELL
Suffix:
Gender:F
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5811 MIDDLE FORK ST
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-5560
Mailing Address - Country:US
Mailing Address - Phone:509-554-9739
Mailing Address - Fax:888-745-2096
Practice Address - Street 1:8514 W GAGE BLVD STE G
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336
Practice Address - Country:US
Practice Address - Phone:509-440-3387
Practice Address - Fax:888-745-2096
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00006097101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)