Individual
JESSICA PENICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
7108 GLADDEN AVE NE, ALBUQUERQUE, NM 87110-1464
(505) 238-6106
Mailing address
7200 MONTGOMERY BLVD NE # 194, ALBUQUERQUE, NM 87109-1510
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3151
NM
Other
Enumeration date
03/02/2007
Last updated
07/08/2007
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