Provider Demographics
NPI:1447087390
Name:PENNINGTON, SKYLER CALLIE (T-LMLP)
Entity type:Individual
Prefix:
First Name:SKYLER
Middle Name:CALLIE
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:T-LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8301 E 49TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64129-2105
Mailing Address - Country:US
Mailing Address - Phone:816-813-2340
Mailing Address - Fax:
Practice Address - Street 1:8301 E 49TH TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64129-2105
Practice Address - Country:US
Practice Address - Phone:816-813-2340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03360-T103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist