MEDICARE: MRS. ANNE ROSEMARIE PENN MA LPC

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	101Y00000X	Counselor	6401007940	MI

General Provider Information

NPI Number	:	1801929138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNE ROSEMARIE PENN MA LPC

Provider Business Mailing Address
First Line	:	1603 CHESTNUT ST
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-5628
Country	:	US
Telephone Number	:	810-255-1818
Fax Number	:

Provider Business Practice Location Address
First Line	:	1603 CHESTNUT ST
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-5628
Country	:	US
Telephone Number	:	810-255-1818
Fax Number	:

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	02/16/2021

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