Provider Demographics
NPI:1780817320
Name:PENNUCCI, DORI ELLEN (MS/CCC/SLP)
Entity Type:Individual
Prefix:
First Name:DORI
Middle Name:ELLEN
Last Name:PENNUCCI
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 1:332 LAUREL CYN
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-4778
Mailing Address - Country:US
Mailing Address - Phone:914-263-2063
Mailing Address - Fax:
Practice Address - Street 1:207 N BOONE ST STE 3
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-5659
Practice Address - Country:US
Practice Address - Phone:423-212-3853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6384235Z00000X
NY019388-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist