Basic Information
| Provider Information | |||||||||
| NPI: | 1649520123 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PENROD | ||||||||
| FirstName: | ALISON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 602 CHERRY ST | ||||||||
| Address2: | |||||||||
| City: | WINDBEE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15936 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5535 S WILLIAMSON BLVD | ||||||||
| Address2: | STE 774 | ||||||||
| City: | PORT ORANGE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003307711 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2012 | ||||||||
| LastUpdateDate: | 09/12/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SL002014L | PA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.