Provider Demographics
NPI:1619708641
Name:PENNINGS, MADELYN (CLC)
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:
Last Name:PENNINGS
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 HIAWATHA AVE
Mailing Address - Street 2:
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-5115
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:642 HIAWATHA AVE
Practice Address - Street 2:
Practice Address - City:VADNAIS HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55127-5115
Practice Address - Country:US
Practice Address - Phone:612-389-7186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
146L00000X, 174400000X
L-319274174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No174400000XOther Service ProvidersSpecialist