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General NPI Number Information
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NPI Number | 1952240830
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Entity Type | Individual
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Provider Name | CHRISTOPHER PENNYWELL SR. CTC
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Gender | Male
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Dates
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Enumeration Date | 03/26/2026
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Last Update Date | 03/26/2026
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Provider Practice Location Address
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Address Line | 47370 WARM SPRINGS BLVD
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City | FREMONT
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State | CA
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Zip | 94539-7458
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Country | US
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Telephone | 559-681-3917
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Fax |
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Provider Business Mailing Address
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Address Line | 4476 N PHOENIX AVE
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City | FRESNO
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State | CA
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Zip | 93723-9583
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Country | US
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Telephone | 559-681-3917
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 210146422
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License Number State | CA
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