Provider Demographics
NPI:1912933896
Name:PENNING, MARJORIE (PHDCCCSLP)
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:
Last Name:PENNING
Suffix:
Gender:F
Credentials:PHDCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 E PARIS AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6139
Mailing Address - Country:US
Mailing Address - Phone:616-949-9531
Mailing Address - Fax:
Practice Address - Street 1:2716 E PARIS AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6139
Practice Address - Country:US
Practice Address - Phone:616-949-9531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI41-2108525235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist