Provider Demographics
NPI:1811368335
Name:JIMENEZ, VIRNALISA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:VIRNALISA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 HASSONITE ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-7212
Mailing Address - Country:US
Mailing Address - Phone:407-353-0298
Mailing Address - Fax:
Practice Address - Street 1:1858 N ALAFAYA TRL
Practice Address - Street 2:SUITE 207
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4728
Practice Address - Country:US
Practice Address - Phone:407-900-5313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA14113235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist