MEDICARE: LYNDAL J PENNER ED.S. LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	045	KS
2	103TC0700X	Clinical Psychologist	142	KS

General Provider Information

NPI Number	:	1043686298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYNDAL J PENNER ED.S. LLC

Provider Business Mailing Address
First Line	:	PO BOX 604
Second Line	:
City	:	HUTCHINSON
State	:	KS
Zip	:	67504-0604
Country	:	US
Telephone Number	:	620-708-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 N MAIN ST STE 416
Second Line	:
City	:	HUTCHINSON
State	:	KS
Zip	:	67501-5250
Country	:	US
Telephone Number	:	620-708-6000
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST/OWNER
Name	:	MR. LYNDAL J PENNER
Credential	:	ED.S.
Telephone Number	:	620-708-6000

Provider Enumeration Date	:	08/11/2015
Last Update Date	:	08/11/2015

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