Provider Demographics
NPI:1508214578
Name:PENNEY, AMANDA JUNE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JUNE
Last Name:PENNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-3911
Mailing Address - Country:US
Mailing Address - Phone:815-670-0776
Mailing Address - Fax:
Practice Address - Street 1:427 MARKET ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-3911
Practice Address - Country:US
Practice Address - Phone:815-670-0776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker