Provider Demographics
NPI:1194151936
Name:PENNINGTON, SUSAN VIRGINIA (MA, MFTI)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:VIRGINIA
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:MA, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-3531
Mailing Address - Country:US
Mailing Address - Phone:208-400-3352
Mailing Address - Fax:
Practice Address - Street 1:1407 N 13TH ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-3531
Practice Address - Country:US
Practice Address - Phone:208-400-3352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor