Provider Demographics
NPI:1033958053
Name:PENROD, DAKOTA LYNN (SLPA)
Entity type:Individual
Prefix:
First Name:DAKOTA
Middle Name:LYNN
Last Name:PENROD
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W JORDAN RANCH RD
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-9262
Mailing Address - Country:US
Mailing Address - Phone:928-530-4903
Mailing Address - Fax:
Practice Address - Street 1:2532 N 4TH ST # 481
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-3712
Practice Address - Country:US
Practice Address - Phone:928-226-1563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA151962355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant