Provider Demographics
NPI:1881055416
Name:CHANG, ELISABEL JIMENEZ (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELISABEL
Middle Name:JIMENEZ
Last Name:CHANG
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 1:4202 E. FOWLER AVENUE, PCD4007
Mailing Address - Street 2:DEPARTMENT OF COMMUNICATION SCIENCES & DISORDERS
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33620
Mailing Address - Country:US
Mailing Address - Phone:646-236-2969
Mailing Address - Fax:
Practice Address - Street 1:4202 E FOWLER AVE STOP PCD1017
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33620-1611
Practice Address - Country:US
Practice Address - Phone:646-236-2969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist