Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Kevin Jon Penner, CCC-SLP

Individual provider Speech-Language Pathologist · NPI 1982377073

Mr. Kevin Jon Penner, CCC-SLP is a Speech-Language Pathologist in Dalton Gardens, Idaho. Licensed in Idaho. Registered with an NPI since 2021.

Licensed in
ID
In the registry since
2021
What do these letters mean?
CCC-SLP — Certificate of Clinical Competence in Speech-Language Pathology
A speech-language pathologist certified by ASHA.

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Practice location Address checks out

6270 N Government Way
Dalton Gardens, ID 83815-9214
Phone: (208) 666-0611
Fax: (208) 664-0566
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Speech-Language Pathologist (primary) Taxonomy 235Z00000X · Licence SLP-4868 (ID)

Record details

NPI number1982377073
Entity typeIndividual (Type 1)
GenderMale
Credentials CCC-SLP
Sole proprietorNo
NPI enumeratedJuly 26, 2021
Last updated in NPPESJuly 26, 2021
Certification dateJuly 26, 2021

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