Provider Demographics
NPI:1841580487
Name:PENNY, LOLA RENEE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LOLA
Middle Name:RENEE
Last Name:PENNY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 TALL PINES DR
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-4456
Mailing Address - Country:US
Mailing Address - Phone:346-617-4591
Mailing Address - Fax:
Practice Address - Street 1:402 E EDGEWOOD DR STE B
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-3891
Practice Address - Country:US
Practice Address - Phone:713-907-1762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-17
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105295235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist