Healthcare Provider Details

I. General information

NPI: 1467473967
Provider Name (Legal Business Name): KARYN E PENNINGTON M.S., CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7380 W SAND LAKE RD SUITE 500
ORLANDO FL
32819-5248
US

IV. Provider business mailing address

1908 VARICK WAY
CASSELBERRY FL
32707-2409
US

V. Phone/Fax

Practice location:
  • Phone: 407-905-9300
  • Fax: 407-905-9309
Mailing address:
  • Phone: 407-905-9300
  • Fax: 407-905-9309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 8133
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License NumberSA 8133
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: