Provider Demographics
NPI:1316261704
Name:PENNEBAKER, ELIZABETH RENAE
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:RENAE
Last Name:PENNEBAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 S KYRENE RD
Mailing Address - Street 2:#225
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-4437
Mailing Address - Country:US
Mailing Address - Phone:480-329-5247
Mailing Address - Fax:
Practice Address - Street 1:17865 SOUTH VAIL RD
Practice Address - Street 2:
Practice Address - City:PICACHO
Practice Address - State:AZ
Practice Address - Zip Code:85141
Practice Address - Country:US
Practice Address - Phone:520-466-7942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA66302355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant