Provider Demographics
NPI:1992030282
Name:PENAFIEL, EMIE ROSE
Entity Type:Individual
Prefix:MS
First Name:EMIE
Middle Name:ROSE
Last Name:PENAFIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:EMIE
Other - Middle Name:R
Other - Last Name:PENAFIEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MACCCSLP
Mailing Address - Street 1:4525 BRITTANY HEYWORTH WAY
Mailing Address - Street 2:APT. #303
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-3177
Mailing Address - Country:US
Mailing Address - Phone:614-668-8653
Mailing Address - Fax:
Practice Address - Street 1:1215 E ORANGE ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5762
Practice Address - Country:US
Practice Address - Phone:863-802-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ4879235Z00000X
FLSA10676235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002790100Medicaid