Provider Demographics
NPI:1902156086
Name:CORREA, PENELOPE ANASTASIA (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:PENELOPE
Middle Name:ANASTASIA
Last Name:CORREA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:PENELOPE
Other - Middle Name:ANASTASIA
Other - Last Name:STOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:DOUGLAS COUNTY HEALTH CENTER-PHYSICAL THERAPY DEPT
Mailing Address - Street 2:4102 WOOLWORTH AVE
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105
Mailing Address - Country:US
Mailing Address - Phone:402-444-7000
Mailing Address - Fax:402-456-0836
Practice Address - Street 1:DOUGLAS COUNTY HEALTH CENTER-PHYSICAL THERAPY DEPT
Practice Address - Street 2:4102 WOOLWORTH AVE
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105
Practice Address - Country:US
Practice Address - Phone:402-444-7000
Practice Address - Fax:402-456-0836
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE319235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist