Provider Demographics
NPI:1679532568
Name:SATTERFIELD, PENI J (MS CCC SLP L)
Entity Type:Individual
Prefix:
First Name:PENI
Middle Name:J
Last Name:SATTERFIELD
Suffix:
Gender:F
Credentials:MS CCC SLP L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4543 CORMORANT DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-8204
Mailing Address - Country:US
Mailing Address - Phone:765-532-7420
Mailing Address - Fax:765-477-9190
Practice Address - Street 1:4543 CORMORANT DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-8204
Practice Address - Country:US
Practice Address - Phone:765-532-7420
Practice Address - Fax:765-477-9190
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004216A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000387861OtherANTHEM PROVIDER NUMBER