Provider Information for 1093422958
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KATILYN JEANETTE PENROD LMFT
Sex: Female
NPI: 1093422958
Last Updated: 2024-09-25
Certification Date: 2024-09-25
Certification Date: 2024-09-25
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1093422958 | ||||||||
| Enumeration Date | 2022-11-01 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | PSC 400 BOX 4304 APO, AP 96273-0044 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 233, DU-RI, PAENGSEONG-EUP CENTERIUM #C401 PYEONGTEAK-SI, GYEONGGI-DO 17975 Korea, Republic of Phone: 103-280-5477 | Fax: | ||||||||
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