Provider Demographics
NPI:1881018901
Name:PENNINO, ADRIANA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:PENNINO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 GAYLORD ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-5630
Mailing Address - Country:US
Mailing Address - Phone:720-509-9702
Mailing Address - Fax:720-509-9702
Practice Address - Street 1:2424 GAYLORD ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5630
Practice Address - Country:US
Practice Address - Phone:720-509-9702
Practice Address - Fax:720-509-9702
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO990235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty