Provider Demographics
NPI:1649353772
Name:NORDIN, PENNY (MA, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:
Last Name:NORDIN
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4062 WATKINS GLEN DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5496
Mailing Address - Country:US
Mailing Address - Phone:404-862-1704
Mailing Address - Fax:770-516-2097
Practice Address - Street 1:4062 WATKINS GLEN DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5496
Practice Address - Country:US
Practice Address - Phone:404-862-1704
Practice Address - Fax:770-516-2097
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002067235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist