Provider Demographics
NPI:1740345784
Name:PENARREDONDA, FRECIA ASTRID (MS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:FRECIA
Middle Name:ASTRID
Last Name:PENARREDONDA
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 1:14841 SW 42ND TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4374
Mailing Address - Country:US
Mailing Address - Phone:786-253-4430
Mailing Address - Fax:888-752-0784
Practice Address - Street 1:14841 SW 42ND TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-4374
Practice Address - Country:US
Practice Address - Phone:786-253-4430
Practice Address - Fax:888-752-0784
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2014-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9446235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000243700Medicaid