Provider Demographics
NPI:1790262004
Name:PENECALE, MARY ROSE (ASSISTAND SLP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ROSE
Last Name:PENECALE
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Gender:F
Credentials:ASSISTAND SLP
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Mailing Address - Street 1:3210 JAIME ZAPATA MEMORIAL HWY STE 5
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-5009
Mailing Address - Country:US
Mailing Address - Phone:956-712-9111
Mailing Address - Fax:956-712-8421
Practice Address - Street 1:3210 JAIME ZAPATA MEMORIAL HWY STE 5
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-5009
Practice Address - Country:US
Practice Address - Phone:956-712-9111
Practice Address - Fax:956-712-8421
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant