Individual provider Active NPI

Sara Johanna Penno, M.S.

  • Speech-Language Pathologist
  • Brandon, FL
National Provider Identifier
1124698022
Registry record updated Jul 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SA20971 Issued in FL
Practice address
206 Ridgewood Ave
Brandon, FL 33510-4617
Phone
(813) 662-1060
NPI assigned
Jul 1, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SA20971 FL Primary

Addresses

Primary practice location

206 Ridgewood Ave
Brandon, FL 33510-4617

Mailing address

3002 W Cleveland St Unit D10
Tampa, FL 33609-3182
Phone (262) 323-4434

Other identifiers 1

IdentifierTypeStateIssuer
10158MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL WebPT Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20250414000503 FL Practitioner - Qualified Speech Language Pathologist 3274057179 Reassigns benefits to 1 organization
I20250613000353 GA Practitioner - Qualified Speech Language Pathologist 3274057179 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
SA20971FLMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Expressable Speech-Language Pathology, P.C. Speech-Language Pathologist CurrentSince Jun 7, 2025 Accepting new patients
Expressable Therapy PC Speech-Language Pathologist CurrentSince Jun 23, 2025 Accepting new patients
Pediatric Therapy Services Inc Speech-Language Pathologist PastSince Jul 4, 2021 Accepting new patients
Pediatric Therapy Services, Inc. Speech-Language Pathologist PastSince Jul 4, 2021 Accepting new patients

Locations

633 W 5th St
Ofc 2876B
Los Angeles, CA 90071

111 N Orange Ave
Ste 800
Orlando, FL 32801
Phone (212) 287-4257

5555 Glenridge Connector
Sandy Springs, GA 30342
Phone (202) 276-9478

5555 Glenridge Connector
Ste 200
Sandy Springs, GA 30342
Phone (404) 459-2516

7600 Chevy Chase Dr
Austin, TX 78752
Phone (512) 649-3880

7600 Chevy Chase Dr
Ste 300
Austin, TX 78752
Phone (512) 318-2503

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1625097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752019200000",
    "number": "1124698022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3002 W CLEVELAND ST UNIT D10",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336093182",
            "telephone_number": "262-323-4434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 RIDGEWOOD AVE",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335104617",
            "telephone_number": "813-662-1060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNO",
        "first_name": "SARA",
        "middle_name": "JOHANNA",
        "credential": "M.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-01",
        "last_updated": "2025-07-09",
        "certification_date": "2025-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA20971",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10158",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "WebPT",
            "affiliation": "N",
            "endpointDescription": "EMR System",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Website",
            "address_1": "206 Ridgewood Ave",
            "city": "Brandon",
            "state": "FL",
            "country_code": "US",
            "postal_code": "335104617",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Brandon, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.