Individual
TRACY MICHELE JIMENEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP-CCC
Contact information
Practice address
430 N MONTE VISTA ST, ADA, OK 74820-4610
(580) 421-1303
Mailing address
515 W KINGS RD, ADA, OK 74820-8125
(602) 499-2016
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3610
OK
235Z00000X
Speech-Language Pathologist
SLP1515
AZ
Other
Enumeration date
08/13/2007
Last updated
08/24/2022
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