Provider Demographics
NPI:1982879870
Name:BARRON, PENNY S (CCC-A)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:S
Last Name:BARRON
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 3RD ST W
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6501
Mailing Address - Country:US
Mailing Address - Phone:707-938-3610
Mailing Address - Fax:707-938-3611
Practice Address - Street 1:511 3RD ST W
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6501
Practice Address - Country:US
Practice Address - Phone:707-938-3610
Practice Address - Fax:707-938-3611
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51222231H00000X
CAAU2940231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K6792Medicare PIN
TX8L26152Medicare PIN