Healthcare Provider Details

I. General information

NPI: 1629650981
Provider Name (Legal Business Name): BETH LYNN PENNINGTON AU.D., CCC/A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 LANDINGS DR STE 207
WASHINGTON PA
15301-9408
US

IV. Provider business mailing address

331 STATE ST
CHARLEROI PA
15022-2629
US

V. Phone/Fax

Practice location:
  • Phone: 724-225-8995
  • Fax:
Mailing address:
  • Phone: 304-668-9258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2201001840
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA-0382
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT006738
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: