Provider Demographics
NPI:1609575190
Name:CLODFELTER, PENNY E (MSW)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:E
Last Name:CLODFELTER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9607 W 131ST ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-4301
Mailing Address - Country:US
Mailing Address - Phone:816-769-0624
Mailing Address - Fax:
Practice Address - Street 1:9607 W 131ST ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-4301
Practice Address - Country:US
Practice Address - Phone:816-769-0624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS46721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical