Provider Demographics
NPI:1619186749
Name:DALRYMPLE, PENNY (LCSW)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:DALRYMPLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 E 100 S
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1501
Mailing Address - Country:US
Mailing Address - Phone:801-359-1114
Mailing Address - Fax:801-359-2874
Practice Address - Street 1:1060 E 100 S
Practice Address - Street 2:SUITE 303
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1501
Practice Address - Country:US
Practice Address - Phone:801-359-1114
Practice Address - Fax:801-359-2874
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000007150Medicare ID - Type Unspecified