Individual
MR. IRVIN ROY PENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSCSW MSW
Contact information
Practice address
5120 E CENTRAL A, WICHITA, KS 67208
(316) 681-3840
(316) 684-5136
Mailing address
11521 WILSHIRE TERRACE, WICHITA, KS 67207-4337
(316) 681-3840
(316) 684-5136
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0159
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7500074901
—
KS
Enumeration date
10/05/2006
Last updated
07/08/2007
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