Individual provider Active NPI

Joan Penna

  • Speech-Language Pathologist
  • Waterbury, CT
National Provider Identifier
1225123441
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
001676 Issued in CT
Practice address
22 Tompkins St
Waterbury, CT 06708-1417
Phone
(203) 419-0381
Fax
(203) 419-0389
NPI assigned
Oct 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 001676 CT Primary

Addresses

Primary practice location

22 Tompkins St
Waterbury, CT 06708-1417

Mailing address

35 Renee CT
Cheshire, CT 06410-1345
Phone (203) 272-7116

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

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1225123441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 RENEE CT",
            "city": "CHESHIRE",
            "state": "CT",
            "postal_code": "064101345",
            "telephone_number": "203-272-7116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 TOMPKINS ST",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067081417",
            "telephone_number": "203-419-0381",
            "fax_number": "203-419-0389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNA",
        "first_name": "JOAN",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CT",
            "license": "001676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterbury, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.