Provider Demographics
NPI:1518150143
Name:PENNER, HEATHER N (ACSW)
Entity Type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:N
Last Name:PENNER
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9343 TECH CENTER DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-2563
Mailing Address - Country:US
Mailing Address - Phone:916-779-2441
Mailing Address - Fax:916-649-7158
Practice Address - Street 1:9343 TECH CENTER DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-2563
Practice Address - Country:US
Practice Address - Phone:916-779-2441
Practice Address - Fax:916-649-7158
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW21769104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker