Provider Demographics
NPI:1285161935
Name:JIMENEZ, JULIA
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3431 N OAKLEY AVE UNIT BASEMENT
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-4884
Mailing Address - Country:US
Mailing Address - Phone:312-549-9190
Mailing Address - Fax:
Practice Address - Street 1:3431 N OAKLEY AVE UNIT BASEMENT
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-4884
Practice Address - Country:US
Practice Address - Phone:312-549-9190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2025-01-20
Deactivation Date:2024-12-12
Deactivation Code:
Reactivation Date:2025-01-14
Provider Licenses
StateLicense IDTaxonomies
106S00000X
IL056.014912225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician