Provider Demographics
NPI:1609071539
Name:PENNINGTON, JACQUELYN BROOKE (MS CF)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:BROOKE
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:MS CF
Other - Prefix:MISS
Other - First Name:JACQUELYN
Other - Middle Name:BROOKE
Other - Last Name:BARKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:424 AKERS DRIVE
Mailing Address - Street 2:
Mailing Address - City:WILMORE
Mailing Address - State:KY
Mailing Address - Zip Code:78232
Mailing Address - Country:US
Mailing Address - Phone:210-273-9610
Mailing Address - Fax:
Practice Address - Street 1:424 AKERS DRIVE
Practice Address - Street 2:
Practice Address - City:WILMORE
Practice Address - State:KY
Practice Address - Zip Code:78232
Practice Address - Country:US
Practice Address - Phone:210-273-9610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103358235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist