MEDICARE: MRS. PENNY NORDIN M.A., CCC/SLP

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	235Z00000X	Speech-Language Pathologist	002067	GA

General Provider Information

NPI Number	:	1649353772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PENNY NORDIN M.A., CCC/SLP

Provider Business Mailing Address
First Line	:	4062 WATKINS GLEN DR
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-5496
Country	:	US
Telephone Number	:	404-862-1704
Fax Number	:	770-516-2097

Provider Business Practice Location Address
First Line	:	4062 WATKINS GLEN DR
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-5496
Country	:	US
Telephone Number	:	404-862-1704
Fax Number	:	770-516-2097

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/09/2007

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Directions to “ MRS. PENNY NORDIN M.A., CCC/SLP” Practice Location

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