Provider Demographics
NPI:1790017358
Name:DENNIS, PENNY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:DENNIS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20296 POPLAR RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20653-3058
Mailing Address - Country:US
Mailing Address - Phone:301-863-9007
Mailing Address - Fax:
Practice Address - Street 1:20296 POPLAR RIDGE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-3058
Practice Address - Country:US
Practice Address - Phone:301-863-9007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02518235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist