Provider Demographics
NPI:1083021380
Name:PENFOLD, ALLISON MICHELLE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:MICHELLE
Last Name:PENFOLD
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:MICHELLE
Other - Last Name:ROSENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:325 E 64TH ST APT 411
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6770
Mailing Address - Country:US
Mailing Address - Phone:845-323-6011
Mailing Address - Fax:
Practice Address - Street 1:140 SAINT EDWARDS ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3904
Practice Address - Country:US
Practice Address - Phone:718-858-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023636-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist