Provider Demographics
NPI:1659979698
Name:PENN, MADLEN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MADLEN
Middle Name:
Last Name:PENN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2963 W DISCOVERY LOOP
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-1257
Mailing Address - Country:US
Mailing Address - Phone:907-444-5005
Mailing Address - Fax:
Practice Address - Street 1:2963 W DISCOVERY LOOP
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-1257
Practice Address - Country:US
Practice Address - Phone:907-444-5005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK183144235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist