Provider Demographics
NPI:1245373927
Name:DRIGGERS, PENNY (MSCCC-SLP)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:DRIGGERS
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:PENNY
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSCCC-SLP
Mailing Address - Street 1:4838 SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:GRACEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32440-5514
Mailing Address - Country:US
Mailing Address - Phone:850-263-7222
Mailing Address - Fax:
Practice Address - Street 1:3203 PRESERVE TRAILS BLVD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32408-7132
Practice Address - Country:US
Practice Address - Phone:850-598-5522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8264235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12052805OtherASHA