Individual
DORI ELLEN PENNUCCI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS/CCC/SLP
Contact information
Practice address
2700 S ROAN ST STE 425, JOHNSON CITY, TN 37601-7587
(423) 212-3853
Mailing address
332 LAUREL CYN, JOHNSON CITY, TN 37615-4778
(914) 263-2063
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
019388-1
NY
235Z00000X
Speech-Language Pathologist
Primary
6384
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q079468
—
TN
Enumeration date
08/31/2009
Last updated
05/20/2024
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