Provider Demographics
NPI:1326788852
Name:VILLAN ORTIZ, JACQUELINE GUADALUPE
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:GUADALUPE
Last Name:VILLAN 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 1:3972 HEATHERWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-2852
Mailing Address - Country:US
Mailing Address - Phone:970-658-7193
Mailing Address - Fax:
Practice Address - Street 1:3972 HEATHERWOOD CIR
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-2852
Practice Address - Country:US
Practice Address - Phone:970-658-7193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker