Healthcare Provider Details

I. General information

NPI: 1487564746
Provider Name (Legal Business Name): REBECCA PENNEL MS, CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 W GEORGE ST APT 1A
CHICAGO IL
60657-5032
US

IV. Provider business mailing address

915 W GEORGE ST APT 1A
CHICAGO IL
60657-5032
US

V. Phone/Fax

Practice location:
  • Phone: 608-220-7568
  • Fax:
Mailing address:
  • Phone: 608-220-7568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242.019092
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: