Provider Demographics
NPI:1255030417
Name:JIMENEZ, JOYCE NICOLE (SLP)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:NICOLE
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. TANAMA 30 INT. CALLE PRINCIPAL
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-5501
Mailing Address - Country:US
Mailing Address - Phone:787-949-0954
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO JUAN BURGOS #28 CARRETERA #2, BO. CANTERA
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-921-2543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4320235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4320OtherLICENCIA PROFESIONAL PERMANENTE