Provider Demographics
NPI:1780273029
Name:PENA, BENITO JR (SLPA)
Entity type:Individual
Prefix:
First Name:BENITO
Middle Name:
Last Name:PENA
Suffix:JR
Gender:M
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-5397
Mailing Address - Country:US
Mailing Address - Phone:956-456-5803
Mailing Address - Fax:
Practice Address - Street 1:526 W 2ND ST
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570-2602
Practice Address - Country:US
Practice Address - Phone:956-230-3301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant