Provider Demographics
NPI:1558881193
Name:TESCH, PENNIE JOY (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PENNIE
Middle Name:JOY
Last Name:TESCH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2524 GLENN AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-2768
Mailing Address - Country:US
Mailing Address - Phone:712-226-2253
Mailing Address - Fax:712-226-2257
Practice Address - Street 1:2524 GLENN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-2768
Practice Address - Country:US
Practice Address - Phone:712-226-2253
Practice Address - Fax:712-226-2257
Is Sole Proprietor?:No
Enumeration Date:2017-06-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01736235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist