Provider Demographics
NPI:1477918555
Name:PENA, ROSA LINDA (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:LINDA
Last Name:PENA
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10060 MCCOMBS ST STE H
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-4245
Mailing Address - Country:US
Mailing Address - Phone:915-408-0699
Mailing Address - Fax:915-503-2297
Practice Address - Street 1:10060 MCCOMBS ST STE H
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-4245
Practice Address - Country:US
Practice Address - Phone:915-408-0699
Practice Address - Fax:915-503-2297
Is Sole Proprietor?:No
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15547235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX293998YS1VOtherMEDICARE