Provider Demographics
NPI:1922485853
Name:JIMENEZ, BRENDA (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:BRENDA
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 1:705 SONIA CIR
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-3749
Mailing Address - Country:US
Mailing Address - Phone:956-223-9337
Mailing Address - Fax:
Practice Address - Street 1:1205 N RAUL LONGORIA RD
Practice Address - Street 2:SUITE I
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589
Practice Address - Country:US
Practice Address - Phone:956-782-5800
Practice Address - Fax:956-782-5802
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX389772355S0801X
TX113498235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX38977OtherSTATE LICENSE