Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | B10000396 | DE |
N | 2080P0006X | Developmental - Behavioral Pediatrician | B10000396 | DE |
NPI | 1033201868 |
---|---|
Provider Name | Dr. Jennifer S. Pendley |
First Address | Rockland, DE 19732-0191 |
Second Address | Wilmington, DE 19803-3607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 21/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001560815 | (05) | PA |
3540111 | (05) | MD |
6596304 | (05) | NJ |
R84040 | (02) |