Provider Demographics
NPI:1649435678
Name:PENFOLD, CASEY R (HAD)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:R
Last Name:PENFOLD
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 COLUMBIA DR STE 1004
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-2363
Mailing Address - Country:US
Mailing Address - Phone:785-551-7525
Mailing Address - Fax:
Practice Address - Street 1:545 COLUMBIA DR STE 1004
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049
Practice Address - Country:US
Practice Address - Phone:785-551-7525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK966237700000X
KS1526237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist