Basic Information
| Provider Information | |||||||||
| NPI: | 1972059673 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JIMENEZ | ||||||||
| FirstName: | JESSICA | ||||||||
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| Credential: | M.S. CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8811 SIENNA SPRINGS BLVD. | ||||||||
| Address2: | APT. # 622 | ||||||||
| City: | MISSOURI CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9565379149 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4828 LOOP CENTRAL DR | ||||||||
| Address2: | SUITE #100 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770812212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139793800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2016 | ||||||||
| LastUpdateDate: | 09/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 108306 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.