Provider Demographics
NPI:1477102168
Name:PENNER, ASHLEY (AUD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:
Last Name:PENNER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:KOHOUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:16699 BOONES FERRY RD STE 11O
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4366
Mailing Address - Country:US
Mailing Address - Phone:503-636-4014
Mailing Address - Fax:
Practice Address - Street 1:9155 SW BARNES RD STE 416
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6631
Practice Address - Country:US
Practice Address - Phone:503-297-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR30785231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist