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Organization

KATHRYN PENFOLD M., SC, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KATHRYN J PENFOLD M, SC (SOLE MEMBER)
(231) 590-6242
Entity
Organization

Contact information

Practice address
820 W FRONT ST, TRAVERSE CITY, MI 49684-2466
(231) 590-6242
Mailing address
820 W FRONT ST, TRAVERSE CITY, MI 49684-2466
(231) 590-6242

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301008173
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1336325281
INDIVIDUAL NPI OF SOLE MEMBER
MI
Enumeration date
04/24/2015
Last updated
04/24/2015
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