MEDICARE: JENNIFER PENNER

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1447702394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER PENNER

Provider Business Mailing Address
First Line	:	6504 ALTA DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-3304
Country	:	US
Telephone Number	:	661-470-1787
Fax Number	:

Provider Business Practice Location Address
First Line	:	6504 ALTA DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-3304
Country	:	US
Telephone Number	:	661-470-1787
Fax Number	:

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

Provider Enumeration Date	:	10/26/2016
Last Update Date	:	10/26/2016

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Directions to “ JENNIFER PENNER ” Practice Location

Language	Start Address	Practice Location

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