Provider Demographics
NPI:1710714092
Name:JIMENEZ, KRYSTINA (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:KRYSTINA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 GOETHALS RD N # 16
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-1436
Mailing Address - Country:US
Mailing Address - Phone:347-920-9310
Mailing Address - Fax:
Practice Address - Street 1:2701 GOETHALS RD N # 16
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-1436
Practice Address - Country:US
Practice Address - Phone:347-920-9310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist