Provider Demographics
NPI:1881922136
Name:FERRIS, PENELOPE J
Entity type:Individual
Prefix:
First Name:PENELOPE
Middle Name:J
Last Name:FERRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PENNY
Other - Middle Name:J
Other - Last Name:FERRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1329 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RIFLE
Mailing Address - State:CO
Mailing Address - Zip Code:81650-2131
Mailing Address - Country:US
Mailing Address - Phone:970-618-0315
Mailing Address - Fax:
Practice Address - Street 1:839 WHITERIVER AVE
Practice Address - Street 2:
Practice Address - City:RIFLE
Practice Address - State:CO
Practice Address - Zip Code:81650-3515
Practice Address - Country:US
Practice Address - Phone:970-665-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-25
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP0002336235Z00000X
NM235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist