Provider Demographics
NPI:1801218045
Name:JIMENEZ, MELISSA (SLPA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2100 W DOLORES LN
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86005-9023
Mailing Address - Country:US
Mailing Address - Phone:602-885-6646
Mailing Address - Fax:
Practice Address - Street 1:20165 N 67TH AVE
Practice Address - Street 2:122A
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7002
Practice Address - Country:US
Practice Address - Phone:602-573-5842
Practice Address - Fax:623-321-1177
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA85632355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant