Provider Demographics
NPI:1235913039
Name:ORTIZ, KATIE J
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:J
Last Name:ORTIZ
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 1:475 WHITLOCK RD
Mailing Address - Street 2:
Mailing Address - City:PURYEAR
Mailing Address - State:TN
Mailing Address - Zip Code:38251-3815
Mailing Address - Country:US
Mailing Address - Phone:731-540-5393
Mailing Address - Fax:
Practice Address - Street 1:889 BELL RD # A
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-3101
Practice Address - Country:US
Practice Address - Phone:615-730-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician