Individual
PENNY L LANDVOGT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH D LLC
Contact information
Practice address
301 E RUSSELL RD, JANESVILLE, WI 53545-9574
(608) 757-1113
Mailing address
301 E RUSSELL RD, JANESVILLE, WI 53545-9574
(608) 757-1113
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
39201800
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39201800
—
WI
Enumeration date
09/01/2006
Last updated
07/08/2007
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