Active NPI
Penny Mickan, M.S.
- Speech-Language Pathologist
- Georgetown, TX
National Provider Identifier
1376909127
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 13962
- Practice address
- 4402 Williams Dr
Georgetown, TX 78628-1300 - Phone
- (512) 256-7627
- NPI assigned
- Jan 10, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 13962 | TX | Primary |
Addresses
Primary practice location
4402 Williams Dr
Georgetown, TX 78628-1300
Mailing address
30230 Oakmont Dr
Georgetown, TX 78628-1109
Phone (512) 869-4536
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13962 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1452384000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1452384000000",
"number": "1376909127",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30230 OAKMONT DR",
"city": "GEORGETOWN",
"state": "TX",
"postal_code": "786281109",
"telephone_number": "512-869-4536"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4402 WILLIAMS DR",
"city": "GEORGETOWN",
"state": "TX",
"postal_code": "786281300",
"telephone_number": "512-256-7627"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICKAN",
"first_name": "PENNY",
"name_prefix": "Mrs.",
"credential": "M.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-01-10",
"last_updated": "2016-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "13962",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Georgetown, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.