Provider Demographics
NPI:1740411859
Name:PENNOCK, DANELLE L (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:DANELLE
Middle Name:L
Last Name:PENNOCK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:DANELLE
Other - Middle Name:L
Other - Last Name:KOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:904 W 23RD ST
Mailing Address - Street 2:STE 101 HEARTLAND PSYCHOLOGICAL SERVICES
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078
Mailing Address - Country:US
Mailing Address - Phone:605-665-0841
Mailing Address - Fax:605-665-0096
Practice Address - Street 1:904 W 23RD ST
Practice Address - Street 2:STE 101 HEARTLAND PSYCHOLOGICAL SERVICES
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078
Practice Address - Country:US
Practice Address - Phone:605-665-0841
Practice Address - Fax:605-665-0096
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD478103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6552900Medicaid
SD6552900Medicaid