Healthcare Provider Details

I. General information

NPI: 1376453134
Provider Name (Legal Business Name): MACY PENNINGTON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506B AUKERMAN ST
EATON OH
45320-1919
US

IV. Provider business mailing address

3149 HARRIS RD
HAMILTON OH
45013-9690
US

V. Phone/Fax

Practice location:
  • Phone: 937-456-3874
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: