MEDICARE: MRS. ALLISON MICHELLE PENFOLD CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	023636-1	NY

General Provider Information

NPI Number	:	1083021380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALLISON MICHELLE PENFOLD CCC-SLP

Provider Business Mailing Address
First Line	:	325 E 64TH ST APT 411
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-6770
Country	:	US
Telephone Number	:	845-323-6011
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 SAINT EDWARDS ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-3904
Country	:	US
Telephone Number	:	718-858-6400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2014
Last Update Date	:	03/19/2019

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Directions to “ MRS. ALLISON MICHELLE PENFOLD CCC-SLP” Practice Location

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