MEDICARE: MRS. KARYN E PENNINGTON M.S., CCC/SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SA 8133	FL
2	222Q00000X	Developmental Therapist	SA 8133	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467473967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KARYN E PENNINGTON M.S., CCC/SLP

Provider Business Mailing Address
First Line	:	1908 VARICK WAY
Second Line	:
City	:	CASSELBERRY
State	:	FL
Zip	:	32707-2409
Country	:	US
Telephone Number	:	407-905-9300
Fax Number	:	407-905-9309

Provider Business Practice Location Address
First Line	:	7380 W SAND LAKE RD
Second Line	:	SUITE 500
City	:	ORLANDO
State	:	FL
Zip	:	32819-5248
Country	:	US
Telephone Number	:	407-905-9300
Fax Number	:	407-905-9309

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	11/12/2015

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Directions to “ MRS. KARYN E PENNINGTON M.S., CCC/SLP” Practice Location

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