MEDICARE: CHRISTINE MCCLARY JIMENEZ M.S. 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	112770	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669111555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE MCCLARY JIMENEZ M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	1805 MAPLELEAF ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76111-1542
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3214 CLINTON AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76106-5858
Country	:	US
Telephone Number	:	817-815-0700
Fax Number	:

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

Provider Enumeration Date	:	05/31/2022
Last Update Date	:	05/31/2022

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Directions to “ CHRISTINE MCCLARY JIMENEZ M.S. CCC-SLP” Practice Location

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