Provider Demographics
NPI:1841539996
Name:PENINGER, SHAYLENE (LCSW)
Entity type:Individual
Prefix:
First Name:SHAYLENE
Middle Name:
Last Name:PENINGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3914 SUMMER SUN
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-8271
Mailing Address - Country:US
Mailing Address - Phone:208-206-3153
Mailing Address - Fax:
Practice Address - Street 1:3914 SUMMER SUN
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-8271
Practice Address - Country:US
Practice Address - Phone:208-206-3153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-10
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW355241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical