Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 071.009147 | IL |
Y | 103TC0700X | Clinical Psychologist | 071.009147 | IL |
NPI | 1003289356 |
---|---|
Provider Name | Dr. Sofia Carleen Jimenez |
First Address | Chicago, IL 60646-2825 |
Second Address | Chicago, IL 60630-2189 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2015 |
Last Update Date | 12/12/2021 |