Provider Demographics
NPI:1609582758
Name:PENNINGTON, COURTNEY DANAE (HAD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:DANAE
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:DANAE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:316 W MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-3162
Mailing Address - Country:US
Mailing Address - Phone:719-686-6800
Mailing Address - Fax:
Practice Address - Street 1:574 W HIGHWAY 105
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9125
Practice Address - Country:US
Practice Address - Phone:719-900-5599
Practice Address - Fax:719-900-5699
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000485237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist