Provider Demographics
NPI:1609098631
Name:PENIX, KENNETH L II (CRC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:L
Last Name:PENIX
Suffix:II
Gender:M
Credentials:CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 NORTHWEST AVE
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278
Mailing Address - Country:US
Mailing Address - Phone:330-926-9445
Mailing Address - Fax:330-926-9551
Practice Address - Street 1:392 NORTHWEST AVE
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278
Practice Address - Country:US
Practice Address - Phone:330-926-9445
Practice Address - Fax:330-926-9551
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator