Individual
MR. KEVIN JON PENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CCC-SLP
Contact information
Practice address
6270 N GOVERNMENT WAY, DALTON GARDENS, ID 83815-9214
(208) 666-0611
(208) 664-0566
Mailing address
6270 N GOVERNMENT WAY, DALTON GARDENS, ID 83815-9214
(208) 666-0611
(208) 664-0566
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-4868
ID
Other
Enumeration date
07/26/2021
Last updated
07/26/2021
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