Provider Demographics
NPI:1982110201
Name:PENYA BILINGUAL SPEECH & LANGUAGE THERAPY INC.
Entity Type:Organization
Organization Name:PENYA BILINGUAL SPEECH & LANGUAGE THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:ILEANA
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:305-301-4870
Mailing Address - Street 1:5600 SPRING PARK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-5989
Mailing Address - Country:US
Mailing Address - Phone:904-694-2800
Mailing Address - Fax:
Practice Address - Street 1:5600 SPRING PARK RD STE 102
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5989
Practice Address - Country:US
Practice Address - Phone:305-301-4870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-21
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13217235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty