Provider Demographics
NPI:1346494259
Name:JIMENEZ, GLADYS CECILIA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:GLADYS
Middle Name:CECILIA
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
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Mailing Address - Street 1:14212 HOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2240
Mailing Address - Country:US
Mailing Address - Phone:646-325-8889
Mailing Address - Fax:347-410-8174
Practice Address - Street 1:6143 186TH ST
Practice Address - Street 2:SUITE C113/114
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11365-2710
Practice Address - Country:US
Practice Address - Phone:646-325-8889
Practice Address - Fax:347-410-8174
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015087-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist