Provider Demographics
NPI:1053679142
Name:JIMENEZ, ANNA MARIA (SLP-A)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:MARIA
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14472 SW 139TH AVE CIR E
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186
Mailing Address - Country:US
Mailing Address - Phone:305-322-3223
Mailing Address - Fax:
Practice Address - Street 1:11005 SW 186 ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157
Practice Address - Country:US
Practice Address - Phone:305-378-5775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2016-02-10
Deactivation Date:2016-01-27
Deactivation Code:
Reactivation Date:2016-02-10
Provider Licenses
StateLicense IDTaxonomies
FLSI17292355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant