Provider Demographics
NPI:1861232084
Name:MATHES, PENNEY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:PENNEY
Middle Name:
Last Name:MATHES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19571 E CAMPBELL RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3264
Mailing Address - Country:US
Mailing Address - Phone:541-639-6858
Mailing Address - Fax:
Practice Address - Street 1:150 SW 25TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2571
Practice Address - Country:US
Practice Address - Phone:541-526-0882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR013351235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist