Provider Demographics
NPI:1972043438
Name:JIMENEZ, DRUCILLA
Entity Type:Individual
Prefix:
First Name:DRUCILLA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 GLEN DR
Mailing Address - Street 2:
Mailing Address - City:KEASBEY
Mailing Address - State:NJ
Mailing Address - Zip Code:08832-1128
Mailing Address - Country:US
Mailing Address - Phone:914-318-8104
Mailing Address - Fax:
Practice Address - Street 1:2 GRIDLEY AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-2204
Practice Address - Country:US
Practice Address - Phone:718-448-7774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist