Provider Demographics
NPI:1174559017
Name:PENNELL, MARLA B (AUD CCC-A)
Entity type:Individual
Prefix:DR
First Name:MARLA
Middle Name:B
Last Name:PENNELL
Suffix:
Gender:F
Credentials:AUD CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 TWIN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-4371
Mailing Address - Country:US
Mailing Address - Phone:512-940-8551
Mailing Address - Fax:512-868-1011
Practice Address - Street 1:375 TWIN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-4371
Practice Address - Country:US
Practice Address - Phone:512-940-8551
Practice Address - Fax:512-868-1011
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50953231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX580068Medicare ID - Type Unspecified