Provider Demographics
NPI:1679874945
Name:PENILLA, AMY SUE (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:SUE
Last Name:PENILLA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 S VICTORIA AVE
Mailing Address - Street 2:#425
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-1292
Mailing Address - Country:US
Mailing Address - Phone:805-390-2639
Mailing Address - Fax:
Practice Address - Street 1:1237 S VICTORIA AVE
Practice Address - Street 2:#425
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93035-1292
Practice Address - Country:US
Practice Address - Phone:805-390-2639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13224235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist