Provider Demographics
NPI:1811217193
Name:PENN, AMBER DAWN REICHELLE (BSW, MAADC II)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:DAWN REICHELLE
Last Name:PENN
Suffix:
Gender:F
Credentials:BSW, MAADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 K ST NW
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-4243
Mailing Address - Country:US
Mailing Address - Phone:918-814-8510
Mailing Address - Fax:
Practice Address - Street 1:5615 W 32ND ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-8161
Practice Address - Country:US
Practice Address - Phone:417-262-6175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker