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Individual

KRISTI SUZANNE PENCE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
635 S MAIN ST STE B, LEITCHFIELD, KY 42754-1056
(270) 287-0656
(270) 230-0328
Mailing address
635 S MAIN ST STE B, LEITCHFIELD, KY 42754-1056
(270) 287-0656
(270) 230-0328

Taxonomy

Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
200211740
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200211740
KY
Enumeration date
11/28/2018
Last updated
11/28/2018
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