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General NPI Number Information
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NPI Number | 1346494259
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Entity Type | Individual
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Provider Name | GLADYS CECILIA JIMENEZ MS CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 11/05/2008
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Last Update Date | 12/04/2015
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Provider Practice Location Address
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Address Line | 6143 186TH ST SUITE C113/114
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City | FLUSHING
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State | NY
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Zip | 11365-2710
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Country | US
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Telephone | 646-325-8889
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Fax | 347-410-8174
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Provider Business Mailing Address
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Address Line | 14212 HOLLY AVE
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City | FLUSHING
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State | NY
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Zip | 11355-2240
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Country | US
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Telephone | 646-325-8889
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Fax | 347-410-8174
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 015087-1
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License Number State | NY
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