Olivia L Pennelle, MSW, CWSA

Primary specialty

Social WorkerTaxonomy code 104100000X

License

A14227 Issued in OR

Practice address

959 SE Division St Ste 520
Portland, OR 97214-4672

Phone

(503) 549-4714

NPI assigned

Oct 18, 2023

Sex

Female

Sole proprietor

No

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

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Second Growth Counseling LLC

  dba Second Growth Counseling

  • Professional Counselor
  • Portland, OR
  • NPI 1871083691
  NPD

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

{
    "created_epoch": "1697587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724716800000",
    "number": "1760264253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 90309",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972900309",
            "telephone_number": "503-549-4714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "959 SE DIVISION ST STE 520",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972144672",
            "telephone_number": "503-549-4714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNELLE",
        "first_name": "OLIVIA",
        "middle_name": "L",
        "credential": "MSW, CWSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-18",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OR",
            "license": "A14227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Morgan Penn, PT
• Regan Ann Penn
• Tristan Penn
• Floyd Martin Penna, LPC, CADC III, CSAT
• Jason Pennell, PHARMD
• Ashley Penner, AU.D.
• Aubra Danielle Penner
• Sara Penner, LCSW
• Mark Edward Pennesi, MD PHD
• Alyssa Penning, MD

• Social Worker in Portland, OR
• Providers in Portland, OR by specialty
• Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.