David R Penner, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY00000896 Issued in WA

Practice address

21907 64TH Ave W
Suite 220
Mountlake Terrace, WA 98043-6200

Phone

(425) 640-9777

Fax

(425) 640-5122

NPI assigned

Mar 18, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 1, 2015 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375401600000",
    "number": "1518081462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60014",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981600014",
            "telephone_number": "425-640-9777",
            "fax_number": "425-640-5122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21907 64TH AVE W",
            "address_2": "SUITE 220",
            "city": "MOUNTLAKE TERRACE",
            "state": "WA",
            "postal_code": "980436200",
            "telephone_number": "425-640-9777",
            "fax_number": "425-640-5122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNER",
        "first_name": "DAVID",
        "middle_name": "R",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-18",
        "last_updated": "2013-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY00000896",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susanne Paris, M.S.L.M.H.C.
• Salley Ko Eun Park, PHARMD
• Amy Parker, MA60811584
• Patricia D Parker, MFT
• Tameka Parker
• Katrina Perez Smith
• Christopher J Peterson, PHD, MA, LMHC-A
• Kimberly Peterson, LMHC
• Selina Petschek, CNM
• Nhat Pham, DDS

• Clinical Psychologist in Mountlake Terrace, WA
• Providers in Mountlake Terrace, WA by specialty
• Clinical Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.