Provider Demographics
NPI:1124233598
Name:PENNINGTON, JOHN C (MA, CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:C
Last Name:PENNINGTON
Suffix:
Gender:M
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 GLEN ECHO RD
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-5860
Mailing Address - Country:US
Mailing Address - Phone:423-928-2939
Mailing Address - Fax:
Practice Address - Street 1:1909 GLEN ECHO RD
Practice Address - Street 2:
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-5860
Practice Address - Country:US
Practice Address - Phone:423-928-2939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP 0000000369235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist