Individual
MS. EMIE ROSE PENAFIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1215 E ORANGE ST, LAKELAND, FL 33801-5762
(863) 802-3800
Mailing address
4525 BRITTANY HEYWORTH WAY, APT. #303, LAKELAND, FL 33813-3177
(614) 668-8653
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA10676
FL
235Z00000X
Speech-Language Pathologist
SZ4879
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002790100
—
FL
Enumeration date
10/05/2009
Last updated
11/10/2010
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