Individual
MADELINE PENNEBAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16 BUCKINGHAM ST APT 2, SOMERVILLE, MA 02143-4313
(617) 475-0462
Mailing address
16 BUCKINGHAM ST APT 2, SOMERVILLE, MA 02143-4313
(713) 498-6194
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
77697
MA
Other
Enumeration date
08/25/2020
Last updated
08/25/2020
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