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NPI Code Detail

MEDICARE: DAVID R PENNER PH.D.

MEDICARE: DAVID R PENNER PH.D.
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
1103TC0700XClinical PsychologistPY00000896WA

General Provider Information

NPI Number : 1518081462
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID R PENNER PH.D.
Provider Business Mailing Address
First Line : PO BOX 60014
Second Line :
City : SEATTLE
State : WA
Zip : 98160-0014
Country : US
Telephone Number : 425-640-9777
Fax Number : 425-640-5122
Provider Business Practice Location Address
First Line : 21907 64TH AVE W
Second Line : SUITE 220
City : MOUNTLAKE TERRACE
State : WA
Zip : 98043-6200
Country : US
Telephone Number : 425-640-9777
Fax Number : 425-640-5122
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2007
Last Update Date : 08/02/2013

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