Jeffry R Penwarden, PHD, LP

NPI #1871544478 in Forest Lake, Minnesota

Provider Information

NPI Number: 1871544478
Entity Type: Individual
Name: Jeffry R Penwarden, PHD, LP
Gender: Not Specified
Sole Proprietor: Not Answered
Primary Specialty: Psychologist - Clinical
Credential: PHD, LP
Enumeration Date: May 16, 2006
Last Updated: Jul 8, 2007

Practice Location

Address: 1540 LAKE ST S
City: Forest Lake
State: Minnesota
ZIP Code: 55025-2628
Phone: (651) 464-7100

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist - Clinical — Clinical	103TC0700X	Primary

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