=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326754193
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA PENNEY LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2023
-----------------------------------------------------
Last Update Date | 07/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2112 OHIO AVE
-----------------------------------------------------
City | SUPERIOR
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54880-4436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-468-2841
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 265
-----------------------------------------------------
City | SHELL LAKE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54871-0265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 11213-125
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------