Provider Demographics
NPI:1932518271
Name:PENROD, EMILY (MSCCCSLP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:PENROD
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9220 BASS LAKE RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55428-3000
Mailing Address - Country:US
Mailing Address - Phone:763-533-0363
Mailing Address - Fax:
Practice Address - Street 1:9220 BASS LAKE RD
Practice Address - Street 2:SUITE 260
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55428-3000
Practice Address - Country:US
Practice Address - Phone:763-533-0363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9101235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist