Healthcare Provider Details

I. General information

NPI: 1396196267
Provider Name (Legal Business Name): PENNIE LYNN MATHEWSON C.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 9TH ST SW
CANTON OH
44707-4714
US

IV. Provider business mailing address

2725 LINCOLN ST E
CANTON OH
44707-2769
US

V. Phone/Fax

Practice location:
  • Phone: 330-454-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2203064
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: