Provider Demographics
NPI:1881178499
Name:PENA, AMY KRISTINE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:KRISTINE
Last Name:PENA
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 1:102 WOLF RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-0014
Mailing Address - Country:US
Mailing Address - Phone:214-991-2827
Mailing Address - Fax:
Practice Address - Street 1:101 REESE DR
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-2376
Practice Address - Country:US
Practice Address - Phone:469-552-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103610235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist