Provider Demographics
NPI:1588208219
Name:PENNINGTON, GRETCHEN MARIE
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:MARIE
Last Name:PENNINGTON
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 1:228 REED ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CREEK
Mailing Address - State:PA
Mailing Address - Zip Code:15840-9734
Mailing Address - Country:US
Mailing Address - Phone:814-592-7578
Mailing Address - Fax:
Practice Address - Street 1:248 SENECA ST STE 304
Practice Address - Street 2:
Practice Address - City:OIL CITY
Practice Address - State:PA
Practice Address - Zip Code:16301-1351
Practice Address - Country:US
Practice Address - Phone:814-678-8627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH002807103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst