Provider Demographics
NPI:1891336210
Name:HALSEY, PENELOPE LASSITER (SCHOOL SLP)
Entity Type:Individual
Prefix:MRS
First Name:PENELOPE
Middle Name:LASSITER
Last Name:HALSEY
Suffix:
Gender:F
Credentials:SCHOOL SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6459 TROUTDALE HWY
Mailing Address - Street 2:
Mailing Address - City:TROUTDALE
Mailing Address - State:VA
Mailing Address - Zip Code:24378-2572
Mailing Address - Country:US
Mailing Address - Phone:276-579-2235
Mailing Address - Fax:
Practice Address - Street 1:6459 TROUTDALE HWY
Practice Address - Street 2:
Practice Address - City:TROUTDALE
Practice Address - State:VA
Practice Address - Zip Code:24378-2572
Practice Address - Country:US
Practice Address - Phone:276-579-2235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2203000395235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist