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General NPI Number Information
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NPI Number | 1184133647
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Entity Type | Individual
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Provider Name | ERICA LYNN PENNELL
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Gender | Female
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Dates
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Enumeration Date | 09/27/2017
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Last Update Date | 09/27/2017
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Provider Practice Location Address
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Address Line | 3303 20TH ST
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City | ROCKFORD
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State | IL
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Zip | 61109-2312
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Country | US
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Telephone | 815-229-2155
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Fax |
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Provider Business Mailing Address
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Address Line | 17025 EAGLES NEST CIR
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City | STRONGSVILLE
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State | OH
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Zip | 44136-6218
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Country | US
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Telephone | 440-821-1630
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146013827
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License Number State | IL
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