Active NPI
Jennifer Lynne Penaranda, CCC-SLP
- Speech-Language Pathologist
- Troy, MI
National Provider Identifier
1154872018
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 7101004808
- Practice address
- 210 Town Center Dr
Troy, MI 48084-1774 - Phone
- (248) 643-8900
- NPI assigned
- Oct 16, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 7101004808 | MI | Primary |
Addresses
Primary practice location
210 Town Center Dr
Troy, MI 48084-1774
Mailing address
375 Virginia CT
Canton, MI 48187-3972
Phone (631) 816-9611
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7101004808 | MI | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1582329600000",
"number": "1154872018",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "375 VIRGINIA CT",
"city": "CANTON",
"state": "MI",
"postal_code": "481873972",
"telephone_number": "631-816-9611"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 TOWN CENTER DR",
"city": "TROY",
"state": "MI",
"postal_code": "480841774",
"telephone_number": "248-643-8900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENARANDA",
"first_name": "JENNIFER",
"middle_name": "LYNNE",
"credential": "CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-10-16",
"last_updated": "2020-02-22",
"certification_date": "2020-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MI",
"license": "7101004808",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Troy, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.