Provider Demographics
NPI:1649361338
Name:MORRIS, PENNY KIMBERLY (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:KIMBERLY
Last Name:MORRIS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MISS
Other - First Name:PENNY
Other - Middle Name:KIMBERLY
Other - Last Name:CHESNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 PLANT AVE
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-3805
Mailing Address - Country:US
Mailing Address - Phone:631-273-1300
Mailing Address - Fax:631-273-4592
Practice Address - Street 1:120 PLANT AVE
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-3805
Practice Address - Country:US
Practice Address - Phone:631-273-1300
Practice Address - Fax:631-273-4592
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013452-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist