Provider Demographics
NPI:1023864725
Name:PENNINGTON, VELVA (LGSW)
Entity type:Individual
Prefix:
First Name:VELVA
Middle Name:
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 LAGOON AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-5004
Mailing Address - Country:US
Mailing Address - Phone:320-223-8744
Mailing Address - Fax:
Practice Address - Street 1:1300 LAGOON AVE STE 270
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-5004
Practice Address - Country:US
Practice Address - Phone:320-223-8744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN30915104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker