Individual
PHYLLIS R PENKETHMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
3349 HWY 138, WALL TOWNSHIP, NJ 07719-9671
(732) 280-6050
Mailing address
PO BOX 213, MANASQUAN, NJ 08736-0213
(908) 773-0752
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
YS001121
NJ
Other
Enumeration date
09/26/2023
Last updated
09/26/2023
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