Provider Demographics
NPI:1215543665
Name:PENA, LESLIE EDNIS
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:EDNIS
Last Name:PENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 TIERRA LINDA BLVD
Mailing Address - Street 2:
Mailing Address - City:PALMVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:78572-5567
Mailing Address - Country:US
Mailing Address - Phone:956-451-0053
Mailing Address - Fax:
Practice Address - Street 1:1005 E 10TH ST STE A
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-5133
Practice Address - Country:US
Practice Address - Phone:956-968-9898
Practice Address - Fax:956-968-9840
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX365212355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant