Provider Demographics
NPI:1831492826
Name:PENA, ELIZABETH D (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:D
Last Name:PENA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 UNIVERSITY STA
Mailing Address - Street 2:2504 A WHITIS, CMA 2,200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78712-0803
Mailing Address - Country:US
Mailing Address - Phone:512-232-5004
Mailing Address - Fax:512-232-1804
Practice Address - Street 1:1 UNIVERSITY STA
Practice Address - Street 2:2504 A WHITIS, CMA 2,200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-0803
Practice Address - Country:US
Practice Address - Phone:512-232-5004
Practice Address - Fax:512-232-1804
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16620235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist