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NPI Code Detail

MEDICARE: MRS. KALA JO PENNINGTON MS CCCSLP

MEDICARE: MRS. KALA JO PENNINGTON MS CCCSLP
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
1235Z00000XSpeech-Language Pathologist2717TN

General Provider Information

NPI Number : 1083702161
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KALA JO PENNINGTON MS CCCSLP
Provider Business Mailing Address
First Line : 459 STETSON COURT
Second Line :
City : MURFREESBORO
State : TN
Zip : 37128
Country : US
Telephone Number : 615-336-1354
Fax Number : 615-217-0342
Provider Business Practice Location Address
First Line : 1173 ROCK SPRINGS RD STE 105
Second Line :
City : SMYRNA
State : TN
Zip : 37167-8414
Country : US
Telephone Number : 615-220-5796
Fax Number : 615-220-8829
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2006
Last Update Date : 08/15/2023

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