Provider Demographics
NPI:1467473967
Name:PENNINGTON, KARYN E (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:KARYN
Middle Name:E
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1908 VARICK WAY
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-2409
Mailing Address - Country:US
Mailing Address - Phone:407-905-9300
Mailing Address - Fax:407-905-9309
Practice Address - Street 1:7380 W SAND LAKE RD
Practice Address - Street 2:SUITE 500
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5248
Practice Address - Country:US
Practice Address - Phone:407-905-9300
Practice Address - Fax:407-905-9309
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 8133235Z00000X, 222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015687100Medicaid