Provider Demographics
NPI:1851684344
Name:PENA, KRISTAL (SLP)
Entity Type:Individual
Prefix:MS
First Name:KRISTAL
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 W SESAME DR
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7930
Mailing Address - Country:US
Mailing Address - Phone:956-399-4500
Mailing Address - Fax:956-399-4505
Practice Address - Street 1:613 W SESAME DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7930
Practice Address - Country:US
Practice Address - Phone:956-399-4500
Practice Address - Fax:956-399-4505
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105770235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist