Provider Demographics
NPI:1609484021
Name:PENA, KIARA DANIELLE
Entity Type:Individual
Prefix:MRS
First Name:KIARA
Middle Name:DANIELLE
Last Name:PENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIARA
Other - Middle Name:DANIELLE
Other - Last Name:DE JESUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1111 SUPERIOR AVE E STE 1800
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-2500
Mailing Address - Country:US
Mailing Address - Phone:216-838-0410
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:4016 WOODBINE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-3286
Practice Address - Country:US
Practice Address - Phone:216-838-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
OHRBT-20-126331106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician