Provider Demographics
NPI:1740486125
Name:BILLINGS, PENNY (SLP)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:BILLINGS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 JOHNSON DR
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:IA
Mailing Address - Zip Code:51601-2436
Mailing Address - Country:US
Mailing Address - Phone:712-246-1249
Mailing Address - Fax:
Practice Address - Street 1:600 MANOR DR
Practice Address - Street 2:
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632-2444
Practice Address - Country:US
Practice Address - Phone:712-542-5161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01711235Z00000X
IA01022235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist