Individual
MS. EARLYN DOROTHY PENGELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., M.S.
Contact information
Practice address
430 PATTERSON AVE, MANKATO, MN 56001-2309
(507) 388-5801
(507) 388-2715
Mailing address
430 PATTERSON AVE, MANKATO, MN 56001-2309
(507) 388-5801
(507) 388-2715
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP1114
MN
1041C0700X
Clinical Social Worker
4137
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
120002
UCARE INSURANCE
MN
01
—
57786PE
BLUE CROSS BLUE SHIELD
MN
01
—
6120605
MEDICA, UBH
MN
01
—
HP28654
HEALTH PARTNERS
MN
Enumeration date
03/23/2007
Last updated
09/11/2025
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