Provider Demographics
NPI:1003040692
Name:JIMENEZ, PATRICIA JANE (MA,CCC-SLP/L)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JANE
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:MA,CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14014 N HEMET DR
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-5884
Mailing Address - Country:US
Mailing Address - Phone:520-907-1027
Mailing Address - Fax:
Practice Address - Street 1:221 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:COOLIDGE
Practice Address - State:AZ
Practice Address - Zip Code:85228-4704
Practice Address - Country:US
Practice Address - Phone:520-424-2169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6145235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist