Provider Demographics
NPI:1629784574
Name:CLEVENGER, PENELOPE SHAYLENE
Entity Type:Individual
Prefix:
First Name:PENELOPE
Middle Name:SHAYLENE
Last Name:CLEVENGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PENELOPE
Other - Middle Name:SHAYLENE
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-0637
Mailing Address - Country:US
Mailing Address - Phone:314-484-8576
Mailing Address - Fax:
Practice Address - Street 1:1326 MAIN ST STE 108
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2471
Practice Address - Country:US
Practice Address - Phone:205-608-3979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist