Provider Demographics
NPI:1821583758
Name:AQUINO, LENA
Entity type:Individual
Prefix:
First Name:LENA
Middle Name:
Last Name:AQUINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6052 MOUNTAIN RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-8110
Mailing Address - Country:US
Mailing Address - Phone:770-868-6042
Mailing Address - Fax:
Practice Address - Street 1:6052 MOUNTAIN RIDGE CIR
Practice Address - Street 2:
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-8110
Practice Address - Country:US
Practice Address - Phone:770-868-6042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-23
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP010185235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty