Kevin Jon Penner, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP-4868 Issued in ID

Practice address

6270 N Government Way
Dalton Gardens, ID 83815-9214

Phone

(208) 666-0611

Fax

(208) 664-0566

NPI assigned

Jul 26, 2021

Last updated

Jul 26, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Synergy Healthcare for Kids Inc.

  • Rehabilitation Clinic/Center
  • Dalton Gardens, ID
  • NPI 1518538685
  NPD

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

{
    "created_epoch": "1627257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627257600000",
    "number": "1982377073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6270 N GOVERNMENT WAY",
            "city": "DALTON GARDENS",
            "state": "ID",
            "postal_code": "838159214",
            "telephone_number": "208-666-0611",
            "fax_number": "208-664-0566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6270 N GOVERNMENT WAY",
            "city": "DALTON GARDENS",
            "state": "ID",
            "postal_code": "838159214",
            "telephone_number": "208-666-0611",
            "fax_number": "208-664-0566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNER",
        "first_name": "KEVIN",
        "middle_name": "JON",
        "name_prefix": "Mr.",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-26",
        "last_updated": "2021-07-26",
        "certification_date": "2021-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "ID",
            "license": "SLP-4868",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Kevinp@synergyidaho.com",
            "affiliation": "N",
            "endpointDescription": "business email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "6270 N Government Way",
            "city": "Dalton Gardens",
            "state": "ID",
            "country_code": "US",
            "postal_code": "838159214",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Madison Mackenzie Miller, OTD, OTR
• Patricia Morgan, REEGT, RPSGT
• Cynthia Elaine Nelson, O.T.R./L
• Kristina Nicholas Anderson, LSW, MASTERS STUDENT
• Open Mind Wellness
• Gabrielle Phillips
• Playwell Pediatric Therapy LLC
• Cindy Jean Radavich, APRN
• Silver Lake Dental PLLC
• Brad Richard Smedley, LMFT

• Speech-Language Pathologist in Dalton Gardens, ID
• Providers in Dalton Gardens, ID by specialty
• Speech-Language Pathologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2021; 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.