Doctor Name: | RAYMOND WESLEY PENNER |
NPI Number: | 1073749982 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 7410 |
Business Practice Address: | 204 S Santa Fe Ave Salina, KS - 674013932 |
Business Phone Number: | 7854930520 |
Business Fax Number: | |
Mailing Address: | 204 S Santa Fe Ave, SALINA |
State: | KS |
Postal Code: | 674013932 |
Phone Number: | 7854930520 |
Fax Number: | |
NPI Enumeration Date: | 06/05/2009 |
NPI Last Update Date: | 06/05/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 7410 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KS |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |