MEDICARE: MISS MEGAN MARIE JIMENO MS CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	LL00003692	WA

General Provider Information

NPI Number	:	1053518282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MEGAN MARIE JIMENO MS CCC-SLP

Provider Business Mailing Address
First Line	:	3708 W ELMHURST AVE
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99208-4812
Country	:	US
Telephone Number	:	509-995-9273
Fax Number	:

Provider Business Practice Location Address
First Line	:	3708 W ELMHURST AVE
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99208-4812
Country	:	US
Telephone Number	:	509-995-9273
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	01/22/2026

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