Provider Demographics
NPI:1124647102
Name:JIMENEZ, CATHERINE ANNE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANNE
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7302 POINSETTA AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CANAVERAL
Mailing Address - State:FL
Mailing Address - Zip Code:32920-3162
Mailing Address - Country:US
Mailing Address - Phone:321-615-5840
Mailing Address - Fax:
Practice Address - Street 1:7302 POINSETTA AVE
Practice Address - Street 2:
Practice Address - City:CAPE CANAVERAL
Practice Address - State:FL
Practice Address - Zip Code:32920-3162
Practice Address - Country:US
Practice Address - Phone:321-615-5840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-10
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR202467235Z00000X
NMSLP-2023-0251235Z00000X
OR17913235Z00000X
FL19453235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist