MEDICARE: MADELYN PENNINGTON

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

General Provider Information

NPI Number	:	1245063312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELYN PENNINGTON

Provider Business Mailing Address
First Line	:	1919 E 2ND ST APT 364
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73034-6231
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14608 BOGERT PKWY
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-2643
Country	:	US
Telephone Number	:	405-784-6981
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2024
Last Update Date	:	08/23/2024

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Directions to “ MADELYN PENNINGTON ” Practice Location

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