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General NPI Number Information
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NPI Number | 1982110201
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Entity Type | Organization
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Legal Business Name | PENYA BILINGUAL SPEECH & LANGUAGE THERAPY INC.
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Dates
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Enumeration Date | 12/21/2017
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Last Update Date | 08/12/2021
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Provider Practice Location Address
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Address Line | 5600 SPRING PARK RD STE 102
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City | JACKSONVILLE
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State | FL
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Zip | 32216-5989
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Country | US
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Telephone | 305-301-4870
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Fax |
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Provider Business Mailing Address
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Address Line | 5600 SPRING PARK RD STE 102
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City | JACKSONVILLE
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State | FL
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Zip | 32216-5989
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Country | US
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Telephone | 904-694-2800
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Fax |
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Authorized Official
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Title or Position | OWNER, SPEECH-LANGUAGE PATHOLOGIST
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Name | MS. VANESSA ILEANA PENA
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Credential | CCC-SLP
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Telephone | 305-301-4870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA13217
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License Number State | FL
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