Provider Demographics
NPI:1801020292
Name:PENA, ELVIRA ELLIE (MS, CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:ELVIRA
Middle Name:ELLIE
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 1:950 DEAF SMITH ST
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-3018
Mailing Address - Country:US
Mailing Address - Phone:956-827-6526
Mailing Address - Fax:
Practice Address - Street 1:950 DEAF SMITH ST
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-3018
Practice Address - Country:US
Practice Address - Phone:956-827-6526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103910235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist