Provider Demographics
NPI:1487832572
Name:JIMENEZ, TAMI LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:LYNN
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6441 PERSHING RD APT 202
Mailing Address - Street 2:
Mailing Address - City:STICKNEY
Mailing Address - State:IL
Mailing Address - Zip Code:60402-4184
Mailing Address - Country:US
Mailing Address - Phone:708-749-4306
Mailing Address - Fax:
Practice Address - Street 1:6441 PERSHING RD APT 202
Practice Address - Street 2:
Practice Address - City:STICKNEY
Practice Address - State:IL
Practice Address - Zip Code:60402-4184
Practice Address - Country:US
Practice Address - Phone:708-749-4306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149012684104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker