Kimberly Penza, SLPA

Primary specialty

Speech-Language AssistantTaxonomy code 2355S0801X

Practice address

31 Greenbriar Dr
Mattoon, IL 61938-9011

Phone

(262) 488-7070

NPI assigned

Mar 7, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1709769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709769600000",
    "number": "1073371704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 GREENBRIAR DR",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619389011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 GREENBRIAR DR",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619389011",
            "telephone_number": "262-488-7070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENZA",
        "first_name": "KIMBERLY",
        "credential": "SLPA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-07",
        "last_updated": "2024-03-07",
        "certification_date": "2024-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2355S0801X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Speech-Language Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tyrese Patterson, RSA
• Tanisha Patton
• Kimberly Dawn Peery, ANP
• Adrian Pelayo, RSA
• Dwight Pentzien, D.O.
• Dominic Perrino, D.O.
• Petersen Health Care II, Inc (Palm Terrace of Mattoon)
• Petersen Management Company, LLC (Palm Terrace of Mattoon)
• Pharmax Inc. (dba Pharmax Pharmacy #0912)
• Philco Dental Group LLC - Mattoon

• Speech-Language Assistant in Mattoon, IL
• Providers in Mattoon, IL by specialty
• Speech-Language Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.