Healthcare Provider Details

I. General information

NPI: 1427773266
Provider Name (Legal Business Name): DAYSI JIMENEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAYSI MENDOZA LCSW

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 09/08/2024
Certification Date: 09/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 W FOREST HOME AVE STE 400
MILWAUKEE WI
53204-3228
US

IV. Provider business mailing address

1432 W FOREST HOME AVE STE 400
MILWAUKEE WI
53204-3228
US

V. Phone/Fax

Practice location:
  • Phone: 414-292-4242
  • Fax:
Mailing address:
  • Phone: 414-292-4242
  • Fax: 414-567-5365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11687123
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11687-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: