Provider Demographics
NPI:1518191154
Name:ORTIZ, CARRIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10455 NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90604-1451
Mailing Address - Country:US
Mailing Address - Phone:562-631-1430
Mailing Address - Fax:562-903-2305
Practice Address - Street 1:10455 NASHVILLE AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90604-1451
Practice Address - Country:US
Practice Address - Phone:562-631-1430
Practice Address - Fax:562-903-2305
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14253235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist