Provider Demographics
NPI:1285750547
Name:BROWN MARTIN, PENNY IRENE (MS CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:IRENE
Last Name:BROWN MARTIN
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:MRS
Other - First Name:PENNY
Other - Middle Name:BROWN
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:200 MILL POND DR
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1468
Mailing Address - Country:US
Mailing Address - Phone:610-363-2204
Mailing Address - Fax:717-445-8371
Practice Address - Street 1:2499 ZERBE RD
Practice Address - Street 2:
Practice Address - City:NARVON
Practice Address - State:PA
Practice Address - Zip Code:17555-9328
Practice Address - Country:US
Practice Address - Phone:717-445-8734
Practice Address - Fax:717-445-8371
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL000460L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASL000460LOtherSLP LICENSE